Testosterone Replacement: Is There Another Way?

Has testosterone replacement therapy (TRT) become the latest big thing? How many men reaching out for testosterone replacement really understand what they are getting themselves into. Whilst there are some obvious benefits, are the risks worth it and is identification of cause and natural resolution a more attractive long term option?

Potential RISKS of Testosterone Replacement Therapy

Whilst the benefits of TRT in men with hypogonadism, may show benefits in libido, sexual function, bone density, muscle mass, body composition, mood, cognition and cardiovascular disease. There are very important potential risks that should alert “user beware”. TRT diminishes the size of the testicles, and compromises fertility, azoospermia (a lack of sperm) this occurs within 10 weeks of beginning therapy, rebound of sperm can take six to eighteen months after cessation of TRT. Other risks include:

  • Stimulate growth of prostate cancer and breast cancer
  • worsen symptoms of benign prostatic hypertrophy
  • cause liver toxicity and liver tumours
  • cause gynecomastia (enlargement of breast tissue)
  • cause erythrocystosis (increase in red blood cells)
  • cause testicular atrophy and infertility
  • cause skin diseases
  • cause or exacerbate sleep apnea

Causes of Low Testosterone & Androgens

Oestrogen!

Checking oestrogen in men is very important, because as oestrogen levels increase so too, does the hormone SHBG (sex hormone binding globulin). SHBG binds to hormones, rendering them inactive, it does this as way of “controlling” them from getting out of hand. So whilst oestrogen stimulates SHBG, its testosterone that it binds to preferentially.

Other

Other causes which need to be considered, may include:

  • obesity
  • cardiovascular disease
  • inflammation
  • smoking
  • alcohol (increases oestrogen)
  • illicit drugs
  • trauma
  • stress
  • radiation
  • medication (SSRI’s, anti psychotics)
  • ageing
  • nutritional adequacy

 Testing

When it comes to testing, its important to look beyond blood testosterone levels. Consider checking total testosterone as well as free testosterone (this is the testosterone that is not bound by SHBG), oestrogen, SHBG, inflammatory markers, DHEA-S, DHT, androstenidione, lutenizing hormone (this hormone is the key trigger for testosterone production) and follicle stimulating hormone. There are other tests that may need to be checked depending on the particular individual.

If erectile dysfunction exists then it is worth also checking homo cysteine levels, as hyperhomocysteinemia is an independent risk factor.

REFERENCES:

NCBI-benefits and risks

Sciencedirect-Anabolic Steroid Induced Hypogonadism in Young Men

JCEM-Testosterone Deficiency in Young Men

Press-Androgens and Bone

ADA-Low Testosterone Associated With Obesity

NCBI-hormone secretion in men

NCBI-risk factor for erectile dysfunction.

Rachel Arthur – Men’s health & Hormones 2015

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