While Testosterone therapy is advertised as a cure-all by some, and a deadly suicide therapy by others, it is neither. Testosterone therapy is all about being normal. Its about being better than sick and better than subsistent; but still just normal.
Like all anti-aging therapies, most of what you hear is absolutely hysterical nonsense! Nobody turns into superman and then dies a horrible death, as the media and medical establishment would have you believe, all because they use medication for normal hormone levels.
Because testosterone therapy is about ensuring optimal normal levels, nobody should expect to suffer the side effects that can occur with supra-physiological ‘doping’ dosages. Unless you have a genetic predisposition to acne and baldness, for example, then there is no reason to expect these to suddenly result from improved normal testosterone levels.
But lets look at some of the claimed side effects on the understanding I am talking about ethical, medical testosterone therapy and not supra-physiological doping:
Despite horror stories about ‘roid-rage’, testosterone therapy has been shown to make men generally happier and more positive. Any increased irritation or aggression with testosterone treatment tends to be caused by an elevated oestrogen level. Ironically it is the feminising hormone that causes the aggression, not the masculinising testosterone. Best practice is to take an aromatase inhibitor to prevent testosterone’s conversion to oestrogen. This favourably improves the balance of hormones, often dramatically improving the mood, libido and body composition response to therapy while reducing risk of prostate issues in the long term. Oestrogen control is a critical element of male health that is typically neglected and/or refused in Australia.
In terms of hair loss, some men may experience an acceleration of baldness they were going to suffer anyway. They can take an anti-DHT drug such as Proscar; but this generally negates some of the major benefits of being on testosterone. Again, if baldness is such a concern that a person wants to take an anti-androgen just to be able to take an androgen (testosterone), the simpler, more logical remedy would be to not take anything.
Cholesterol & Heart Disease
The transient worsening of cholesterol profile that sometimes accompanies testosterone therapy is a reflection of being in a pro-repair, anabolic state. Nobody suddenly dies of heart disease when their testosterone levels increased dramatically during puberty. And nobody is likely to suddenly contract heart disease because they normalise their testosterone levels in their 40’s and 50’s. The cardiac profile of many people actually improves. And the profile of most patients (whose profile does “worsen” to reflect the state of anabolism) corrects within 1-3 years to being better than when they started.
In terms of testosterones effect on acne, if acne has always been a problem for someone then it may get worse with testosterone therapy. If acne does develop, the simplest remedy is to use a lower dose of testosterone or simply not to go on testosterone replacement at all. Most men on testosterone therapy do not develop acne.
Gynecomastia – female breast tissue development – is another issue caused by conversion of testosterone to oestrogen. As discussed above, an aromatase inhibitor should be considered essential with testosterone therapy. Otherwise, gynecomastia requires surgery to remove.
While a point of much contention and disagreement (like much about modern western medicine), some more contemporary doctors actually treat prostate disease with testosterone and/or DHT therapy. There is much evidence that, again, the primary culprit in prostate issues stems from the imbalance between testosterone and estrogen. An aromatase inhibitor is a good step in the right direction.
Of course, as with all side effects mentioned here, if someone has a pre-existing condition or familial history of problems then the simplest, most obvious solution is not to take testosterone unless absolutely necessary (from very clinically low levels).
Testosterone Problem Avoidance?
Taking weaker forms of testosterone, such as creams and patches, is generally so lacking in subjective benefit that most patients don’t even bother continuing after a few months of treatment. In research, even 70% of hypogonadal geriatrics quit within 3 months for lack of effect!
The most aggressive injection protocols (for normal levels) still only achieve subjective normalcy over the longer term. Other than someone born without testosterone, nobody becomes a new man like they have never been – for better or worse – despite what the propaganda suggests. They might become a renewed man. But not better than their best normal self of the past. And the body adjusts to operate on any level of testosterone. So any increase in energy, libido, muscularity and wellbeing that might be experienced upon initiating testosterone therapy subsides to normal anyway.
If you are a male, over 35 years old, and have low-normal testosterone then testosterone therapy might be an option that may help improve your quality of life. If it decreases your quality of life by accelerating your baldness, giving you acne and causing you to want to take anti-androgen and cholesterol medications, then you would probably be better off not taking it.
There is no guarantee that any man’s natural testosterone requires improvement in the first place. Most men who come to Recomp Medical, convinced they have low testosterone, actually prove to have extremely good testosterone levels when tested. Though they suffer telltale signs of low testosterone – low libido, depression, lethargy, fat gain, muscle loss etc – their problems are caused by other factors; usually the typical high stress job, poor sleep, miserable marriage, bad diet, inappropriate exercise etc. These things often cause reduced testosterone too.
Testosterone therapy is pointless in someone with decent natural levels. Testosterone level increases of 100% or less are basically academic. After barely a few weeks, any initial boost to energy and libido will have returned to normal but physiological dependence to therapy will start to develop.
The only way to truly know if testosterone therapy is relevant, and then whether it is appropriate, is to do blood tests and measure it. Any fears or expectations of morphing into a psychopathic, bald, muscular, walking erection with acne, and then keeling over dead with liver, kidney, prostate and heart failure should be heavily tempered with a giant reality check!