IS TESTOSTERONE REPLACEMENT THERAPY SAFE?
Written by David L. Jones
(Important Note: this blog is intended for informational purposes only. Contact your medical provider for treatment or official medical advice. For additional information or medical advice, you may contact WellLife Medical Centers at (719)694-8782.)
The safety of testosterone replacement therapy (TRT) is a debated topic within the medical community. Although medical concerns have decreased substantially over the past decade, some medical professionals, especially those that do not specialize in testosterone therapy, still hold on to old theories. There are many proven ways to ensure minimal side-effects and a high level of safety for those who would benefit from TRT. There are many studies that advocate for TRT, highlighting its benefits, and others that caution against it, primarily due to concerns about cardiovascular health. Having managed a successful medical practice specializing in hormone therapy for men and women for nine years and as a medical provider for over 20 years, I aim to review the most prominent studies, compare their findings, and discuss the health outcomes observed in thousands of patients under our care.
The Benefits of TRT
Testosterone replacement therapy has shown to potentially improve various aspects of health, including:
– Libido and sexual function
– Mood and emotional well-being
– Sleep quality
– Erectile dysfunction
– Muscle strength and recovery
– Memory and concentration
– Depression and anxiety
– Energy levels and reduction of fatigue
– Muscle and joint pain
– Weight management
– Skin and hair health
Now, let’s get straight to the point:
Testosterone replacement therapy, when administered correctly and with proper medical supervision, is not only safe but highly beneficial for millions of men (and some women).
The Importance of Proper Medical Supervision
The emphasis on “proper” medical supervision is crucial. Many healthcare providers lack the specialized training and experience required to safely administer hormones. Additionally, certain business models, especially franchises with multiple locations, may not dedicate enough time or resources to ensure patient safety, often prioritizing profit over health. This can lead to improper treatment, which significantly raises health risks. Franchises may also hire practitioners with limited expertise in hormone therapy, contributing to negative outcomes.
In our practice, we have treated numerous patients who previously received inadequate care from such franchises, placing them at serious health risk. The lack of expertise in hormone therapy appears to be a major factor contributing to studies that report higher risks associated with TRT.
Cardiovascular Risks and TRT: A Balanced View
Before starting TRT, patients should be thoroughly evaluated for cardiovascular issues by a qualified medical provider. If cardiovascular problems cannot be resolved, TRT is not recommended. One of the key metrics to monitor during TRT is hematocrit, a test that measures the volume of red blood cells. While having slightly elevated red blood cell counts can improve oxygen distribution and physical endurance, excessively high hematocrit levels can thicken the blood, increasing blood pressure and strain on the heart.
Proper monitoring is essential. For men self-administering TRT without medical supervision, the risks increase dramatically. However, with correct monitoring, TRT can be very safe, and studies even suggest it may improve heart function, as the heart is a muscle that can benefit from testosterone.
A body of evidence suggests a connection between low testosterone levels and cardiovascular disease (CVD). While some studies raise concerns about TRT increasing cardiovascular risks, these have been criticized for poor analysis and lack of conclusive evidence. In fact, a scientific review of these studies concluded that “there has not been a single study that has provided definitive evidence to support the concern that TRT increases CV risk”. Another study highlights that testosterone insufficiency in older men is linked to an increased risk of death.
Estrogen Levels and Their Critical Role
While testosterone is the focus of TRT, maintaining healthy estrogen levels is equally important. Both high and low estrogen levels have been linked to cardiovascular disease, prostate issues, dementia, osteoporosis, stroke, type II diabetes, and higher mortality rates. For example, studies have shown that low testosterone is associated with a 65% increase in all-cause mortality, while low estrogen increases mortality by 54%.
The ideal range for estrogen levels in men undergoing TRT is between 20–30 pg/mL. Regular monitoring of these levels can prevent potential complications.
Prostate Health and TRT
Ensuring prostate health is another critical factor when considering TRT. Don’t worry men, old-fashioned and evasive prostate exams are not necessary. Through highly accurate blood work we can check prostate health with even higher levels of accuracy than the old manual exams.
Practical Tips for Safe TRT
To ensure safe and effective testosterone replacement therapy, here are some practical tips:
- Regular Blood Work: Your provider should check testosterone, estrogen, hematocrit, and prostate health before starting TRT and at least twice a year during treatment.
- Monitor Blood Pressure: Routine blood pressure checks can help identify cardiovascular risks early and guide hematocrit testing frequency.
- Estrogen Management: If you experience mood swings, irritability, or anger, elevated estrogen may be the cause. Discuss the use of estrogen blockers with your provider.
- Symptom Monitoring: Providers should regularly assess any symptoms that could indicate hormonal imbalances or side effects. This increases the likelihood of timely interventions.
TRT Costs and Accessibility
The cost of TRT varies depending on individual needs, but generally falls between $300 and $400 per month. Some clinics may charge more, but it’s important to ensure you’re not overpaying. Our practice offers TRT therapy starting at $325 per month, with additional discounts available. Many insurance plans will contribute or pay for TRT and we also accept most commercial insurance plans, including Tricare and VA.
For more information about TRT, or to schedule a consultation, please contact WellLife Medical Centers at (719) 694-8782. Our Colorado Springs location specialize in men’s health and wellness, including TRT, sleep apnea, erectile dysfunction, and more.
Citations:
- “Testosterone and Cardiovascular Disease: A Review of the Literature,” *Journal of Clinical Endocrinology and Metabolism*, 2022.
- “TRT and Cardiovascular Risk: A Scientific Review,” *Endocrine Reviews*, 2023.
- “Testosterone Insufficiency and Mortality in Aging Men,” *The American Journal of Medicine*, 2022.
- “The Role of Estrogen in Male Cardiovascular Health,” *Nature Reviews Cardiology*, 2021.
- “Evaluating the Risks of Testosterone Therapy,” *Journal of the American College of Cardiology*, 2022.
- “Hormonal Imbalances and Mortality Rates in Men,” *European Heart Journal*, 2023.
