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.)

Many people inquire into the benefits, safety, and side effects of Testosterone Replacement Therapy (TRT); so, I thought I would address the topic.

IS TRT SAFE?

This is a debated topic in the medical field. There are studies that endorse and studies that warn, most often related to the topic of cardiovascular health. We have ran a successful medical practice that specializes in men’s and women’s hormone therapy for years, so I thought would review the most prevalent studies, and compare them against other studies, as well as the results and health effects we have experienced when caring for hundreds of patients who have received this therapy.
Benefits of TRT may include imrovements in the following: libido, mood, sleep, erectile dysfunction, muscle strength and recuperation, memory and concentration, depression, energy, fatigue, muscle and joint pain, weight, dry hair and dry skin.
I always like to begin with the bottom-line up front to save the reader time and energy, and allows the reader to process the point, as he or she reads through the information. So here it is:

Testosterone Replacement Therapy, administered correctly and with proper medical supervision is not only safe, but highly beneficial for millions of men (and for some women as well).

Notice the emphasis on “proper” medical supervision. The reason for this particular focus is that many medical providers have not been properly trained and/or do not have the necessary experience to properly administer hormones to patients. Also, many medical business models, especially franchises that have numerous locations do not allow for enough time, blood work, or pay appropriate attention to critical aspects of patient health and safety. Usually, this is due to a preference to earn more money, as opposed to ensuing patient health. Another challenge, franchises require numerous providers and there are so few with this expertise that they predominately hire those that have current medical credentials, but are without the necessary hormone related experience. I have seen so many patients that have come from the box franchises that are at serious health risk. Lack of medical experience involving hormones dramatically increases patient risk and also appear to increase the number of studies in circulation that address the higher risk.

I will try to keep it simple and not get too scientific. If you want additional information, I have referenced numerous articles below that will provide specific studies and scientific results.

IS THERE GREATER CARDIOVASCULAR RISKS ASSOCIATED WITH TRT?

First and foremost, patients should be tested for cardiovascular issues by a medical provider prior to starting therapy. If a patient’s cardiovascular issues cannot be resolved, testosterone replacement therapy is not recommended. Other than a patient being at high risk, due to cardiovascular disease, another key factor is hematocrit. Hematocrit is a blood test that measures the volume of red blood cells in the body. Primary purpose of red blood cells is to distribute oxygen to the body. Having a few more red blood cells with good blood pressure and heart health may assist with energy and physical endurance. For instance, most people have a normal increase in red blood cells when living at higher altitudes. With decreased oxygen available in the air, this allows for better oxygenation. Many patients, however, will make even more red blood cells on TRT, but most stay within normal perimeters. Still some patients will experience the side-effect of elevated hematocrit beyond recommended perimeters. This side-effect can increase blood thickness, thus increasing blood pressure and placing an additional workload on the heart. These patients must be monitored more often, paying additional attention to blood pressure and hematocrit. Failure to monitor correctly, especially those men that are self-administering without medical supervision can tremendously elevate cardiovascular risk. Nevertheless, when monitored correctly, it is very safe and men can experience many benefits, including improved heart function; after all, the heart is a muscle that can be strengthened. Lack of medical supervision, as well as the absence of experienced and proper monitoring, are highly suspected to be the primary reasons that many studies show men at greater risk on therapy. There is supporting evidence from both clinical studies and clinical scientific reviews that display a link between low testosterone and cardiovascular (CV) disease. There are studies that oppose such results, but they have been serious criticized through peer reviews for poor analysis, lack of evidence, and improper and illogical conclusions (see references)1 One scientific review of recent studies that oppose TRT has concluded that “Testosterone deficiency is associated with a poorer quality of life, reduced physical strength and lean muscle mass, fatigue, among many other symptoms and clinical parameters that may lead to earlier mortality. Until date, there has not been a single study that has provided definitive evidence to support the concern that TRT increases CV risk.”2 Another says, that Testosterone insufficiency in older men is associated with increased risk of death.3

ESTROGEN LEVELS ARE VERY IMPORTANT TO GOOD HEALTH AND EXTREMELY IMPORTANT WHILE ON TRT THERAPY.

Estrogen levels outside normal perimeters, both high and low, have many valid scientific studies that have proven a connection to increased cardiovascular and prostate disease, dementia, alzheimers, osteoporosis, stoke, type II diabetes, as well as overall higher mortality rate.5-29 A prominent study shows that low testosterone in men causes a 65% greater all-cause mortality, and men with low estrogen suffered 54% more deaths.3-4 Numerous peer reviewed and collaborative scientific studies and medical journals have displayed evidence that shows that the safest and most healthy levels of estrogen in men are between 20pg/mL and 30pg/mL.

PROSTATE EXAMS ARE IMPORTANT TO MEN’S HEALTH IN GENERAL AND IT IS VERY IMPORTANT TO ENSURE GOOD PROSTATE HEALTH PRIOR TO AND WHILE ON TRT THERAPY.

It is very important to perform prostate testing before and during TRT therapy. This does not have to be done manually (the old -fashioned way). This can also be done through simple bloodwork, which is actually much more definitive and accurate.
I know I did not get into the scientific evidence behind the pros and cons of TRT and Estrogen, but I have provided references, as well as attached many other competent and collaborative studies below that provide this information.

*Important Tips for good health and safety when starting TRT.
1. Ensure that your medical provider is at the very minimum performing blood work to check your testosterone, estrogen, hematocrit, and prostate health prior to therapy and at least twice a year while on therapy. If levels are above or below recommended levels, they should be addressed. (for men prone to elevated hematocrit your provider should perform test more often to ensure that levels always stay within normal limits. If you are too high, giving blood should decrease hematocrit to safe levels.
2. Provider’s office should be checking you blood pressure often. This will allow prompt notice of any cardiovascular issues. It also may help ascertain good timing for hematocrit testing.
3. If you are feeling strange, moody, irritable, and angry it is likely not the testosterone and is most likely elevated estrogen levels. Most men will require estrogen blockers to maintain healthy and safe levels. Be upfront with your provider and ask them directly if you should be taking estrogen blockers.
4. Your medical provider should have a list of symptoms related to men’s health, particularly, patient risk, borderline areas and potential side effects. These symptoms should be addressed periodically depending upon patient. This increases awareness in men, thus improving the ability and likelihood for patients and providers to address issues in a preventive or timely manner.
Note: Testosterone Replacement Therapy Cost? Average cost associated with testosterone replacement therapy depends upon the patient’s need; however, many times the basic therapy is between $200-$290. If you are paying more than that you are paying too much. #TestosteroneReplacementTherapy.

For any Questions or interest in TRT…
Please contact WellLife Medical Centers at (719) 694-8782, www.welllifemedctr.com, welllifemedctr.com/services/testosterone-replacement-therapy/. WellLife Medical Centers in Colorado Springs are experts in TRT and others services related to men’s wellness, including: sleep apnea, erectile dysfunction, annual physicals and screenings, depression, mood swings, allergies, hypertension (high blood pressure), thyroid disorders, high cholesterol, diabetes and many others. Our mission is to provide great medical services, convenience, great prices, and one-stop shopping. We know that most men would prefer not to go to the doctor’s office, so we make every effort to ensure that your experience is much better than the standard expectation. Our TRT therapy starts at $239 a month, which includes treatments to ensure safe estrogen level. Many discounts are available for cash options; for instance, 10% off for military, first responders, government service, and more. We also take most commercial health insurance plans, as well as, Tricare and VA Choice. We look forward to caring for your health.

References
1. Nat Rev Cardiol. 2019 Sep;16(9):555-574. doi: 10.1038/s41569-019-0211-4. Research Program in Men’s Health: Aging and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA.
2. Jones TH, Saad F. The effects of testosterone on risk factors for, and the mediators of, the atherosclerotic process. Atherosclerosis. 2009;207: 318–271.
3. Laughlin GA, Barrett-Connor E, Bergstrom J. Low serum testosterone and mortality in older men. J Clin Endocrinol Metab. 2008; 93:68–75.
4. Tivesten A, Vandenput L, Labrie F, et al. Low serum testosterone and estradiol predict mortality in elderly men. J Clin Endocrinol Metab. 2009 Jul;94(7):2482-8.
5. Tan S, Sohrabi HR, Weinborn M, Tegg M, Bucks RS, Taddei K, Carruthers M, Martins RN. Am J Geriatr Psychiatry. 2019 Nov;27(11):1232-1246. doi: 10.1016/j.jagp.2019.05.008. Epub 2019 May 20.
6. K, Suzuki T. Endocrine environment of benign prostatic hyperplasia prostate size and volume are correlated with serum estrogen concentration. Scand J. Urol Nephrol. 1995 Mar;29(1):65-8.
7. Klaiber EL, Broverman DM, Haffajee CI, Hochman JS, Sacks GM, Dalen JE. Serum estrogen levels in men with acute myocardial infarction. Am J Med. 1982 Dec;73(6):872-81.
8. Lindholm J, Eldrup E, Winkel P. Variability in plasma oestrogen concentrations in men with a myocardial Infarction. Dan Med Bull. 1990 Dec;37(6):552-6.
9. Zumoff B. Hormonal abnormalities in obesity. Acta Med Scand Suppl. 1988; 723:153-60.
10. Small M, MacRury S, Beastall GH. Oestradiol levels in diabetic men with and without a previous myocardial infarction. Q J Med. 1987 Jul;64(243):617-23.
11. Abbott RD, Launer LJ, Rodriguez BL, et al. Serum estradiol and risk of stroke in elderly men. Neurology. 2007 Feb 20;68(8):563-8.
12. Jeppesen LL, Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS, Winther K. Decreased serum testosterone in men with acute ischemic stroke. Arterioscler Thromb Vasc Biol. 1996 Jun;16(6):749-54.
13. Phillips GB, Pinkernell BH, Jing TY. The association of hypotestosteronemia with coronary artery disease in men. Arterioscler Thromb. 1994 May;14(5):701-6.
14. Phillips GB. Evidence for hyperestrogenemia as the link between diabetes mellitus and myocardial infarction. Am J Med. 1984 Jun;76(6):1041-8.
15. Dunajska K, Milewicz A, Szymczak J, et al. Evaluation of sex hormone levels and some metabolic factors in men with coronary atherosclerosis. Aging Male. 2004 Sep;7(3):197-204.
16. Wranicz JK, Cygankiewicz I, Rosiak M, Kula P, Kareba W. The relationship between sex hormones and lipid profile in men with coronary artery disease. Int J Cardiol. 2005 May 11;101(1):105-10.
17. Jankowska EA, Rozentryt P, Ponikowska B. Circulating estradiol and mortality in men with systolic chronic heart failure. JAMA. 2009 May 13;301(18):1892-901.
18. Cutolo M, Seriolo B, Villaggio B, Pizzorni C, Craviotto C, Sulli A. Androgens and estrogens modulate the immune and inflammatory responses in rheumatoid arthritis. Ann NY Acad Sci. 2002 Jun;966:131-42.
19. Gann PH, Hennekens CH, Longcope C, Verhoek-Oftedahl W, Grodstein F, Stampfer MJ. A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia. Prostate. 1995 Jan;26(1):40-9.
20. Shibata Y, Ito K, Suzuki K, et al. Changes in the endocrine environment of the human prostate transition zone with aging: simultaneous quantitative analysis of prostatic sex steroids and comparison with human prostatic histological composition. Prostate. 2000 Jan;42(1):45-55.
21. Matsuda T, Abe H, Suda K. Relation between benign prostatic hyperplasia and obesity and estrogen. Rinsho Byori. 2004 Apr;52(4):291-4.
22. Singh PB, Matanhelia SS, Martin FL. A potential paradox in prostate adenocarcinoma progression: oestrogen as the initiating driver. Eur J Cancer. 2008 May;44(7):928-36.
23. Mellström D, Vandenput L, Mallmin H, et al. Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. J Bone Miner Res. 2008 Oct;23(10):1552-60.
24. Pernow Y, Hauge EM, Linder K, Dahl E, Sääf M. Bone histomorphometry in male idiopathic osteoporosis. Calcif Tissue Int. 2009 Jun;84(6):430-8.
25. Moffat SD, Zonderman AB, Metter EJ, Blackman MR, Harman SM, Resnick SM. Longitudinal assessment of serum free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab. 2002 Nov;87(11):5001-7.
26. Hogervorst E, Combrinck M, Smith AD. Testosterone and gonadotropin levels in men with dementia. Neuro Endocrinol Lett. 2003 Jun;24(3-4):203-8.
27. Gouras GK, Xu H, Gross RS, et al. Testosterone reduces neuronal secretion of Alzheimer’s beta-amyloid peptides. Proc Natl Acad Sci USA. 2000 Feb 1;97(3):1202-5.
28. Traish AM, Saad F, Guay A. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl. 2009 Jan-Feb;30(1):23-32.
29. Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) Prospective Population Study. Circulation. 2007 Dec 4;116(23):2694-701.
30. 29. Hak AE, Witteman JC, de Jong FH, Geerlings MI, Hofman A, Pols HA. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab. 2002 Aug;87(8):3632-9.