Testosterone replacement treatment is widely common to treat men with symptomatic hypogonadism. The advantages that come with TRT, such as increased libido, a boost of energy, it has beneficial effects on muscle mass, bone density, muscle strength and cardioprotective effects as well, have been openly talked about and documented. Men who have not been given the care of prostate cancer should not opt for testosterone replacement therapy as it could have major risks. Patients who are on TRT should be continuously monitored for any side effects, such as peripheral edema, polycythemia or hepatic and cardiac dysfunction.
Testosterone brings a number of benefits for a male body, which includes increased bone density and strength, libido and increase in sex drive hematopoiesis and all the benefits which have been already talked about earlier in the article. With time and men ageing, men are normally to face decreased levels of testosterone. Which has been stated in the Baltimore Longitudinal Study Of Ageing as well, that 20% men after the age of 60 are affected by hypogonadism, 30% men after the age of 70 and 50% men after the age of 80 face hypogonadism.
As men grow older, there has been seen a decline in testosterone production and an increase in sex hormone-binding globulin as well, which in turn is responsible for the decrease of bioavailable testosterone. Keeping these declines in consideration, the beneficial effects of testosterone replacement therapy is overcome by the negative effects of it to the emotional and physical well being. TRT is often suggested by doctors to men who face low levels of testosterone or and men who symptoms of hypogonadism. Once the hormone replacement therapy for men is done, the positive effects of the hormones return are restored. Looking at the positive results, a lot of men are opting for TRT treatment without looking at the long term effects TRT treatment bring along, which is lacking on safety.
Due to wide publication and mostly undisputed beneficial effects of TRT treatment, the possible risks and complications are often neglected by men. Men who show co-occurring symptoms of low levels of testosterone and are opting for TRT therapy should know all the risks before getting into it. There could be side effects like breast cancer for men, acute severity in prostate cancer, worsening of benign prostatic hyperplasia (BPS) increased risk of sleep apnea and polycythemia should be informed of to the patients before suggesting TRT therapy. The risks and complications faced by male hormone replacement therapy will be discussed in length in the article.
TRT Effect On Prostate Cancer
Hodges and Huggens described the connection between the progression of prostate cancer and serum testosterone levels some 60 years ago. Later on in the year 1982, it was reported that metastatic prostate cancer patients who are injected with exogenous testosterone have even worse outcomes. African-American and men with first degree relatives with prostate cancer and men diagnosed with prostate cancer are considered as high-risk patients of TRT therapy, and it should not be used in these patients.
In recent years, there has been a drastic change in the use of TRT therapy, despite the risks associated with it. Because of the failure of a lot of longitudinal studies which showed a connection between prostate cancer and endogenous testosterone levels. Men on no TRT therapy are as much likely to be caught in prostate cancer, as men on TRT therapy. For patients who have already gone through prostate cancer treatment, TRT therapy does not have significant risks, which is making it more acceptable to be practised on the ex-patients of prostate cancer.
The use of TRT therapy on patients who have already undergone radical prostatectomy is a common practice now, because of the eliminated risks of reoccurrence of prostate cancer. However, the same can not be said about patients who have untreated prostate cancer. Although, a lot of studies have revealed that male hormone replacement therapy does not associate with a reoccurrence of or production of prostate cancer, which has been proven by gleason grade upstaging on repeat biopsy. A lot of hypogonadal or untreated prostate cancer men have received male hormone replacement therapy and no progression of prostate cancer or any other associated disease was shown afterwards.
While a lot of adults have been reported to get caught in metastatic prostate cancer after hormone replacement therapy for men, these reports are often unreliable. Which makes the practitioners of TRT therapy on older men somewhat reluctant, because they could be at a higher risk of getting prostate cancer or have symptoms of underlying low-grade diseases. To move free of any doubt, patients should be monitored frequently for any change during 3 to 6 months of hormone replacement therapy, for changes or any sign of cancer which could be already existing in the male body. In which case, hormone replacement therapy should be instantly ended. Everything combined together directs towards regular rejection of occurrence of prostate cancer in older man on the administration of TRT, however, it should be done with a lot of caution in hypogonadal men or patients treated with high prostate cancer symptoms.
Although there is no direct link of testosterone hormone to the development of breast cancer in men, it has been indicated that increased testosterone levels can cause increased aromatization to an active derivative of estrogen, which in turn can ultimately cause breast tissue receptors and can increase the breast cancer risk in male. Medical experts are yet to fully understand the active role of testosterone in the development of breast cancer.
While there may be an indication of increased risks of breast cancer in men which are caused by high testosterone levels, the direct connection of TRT therapy or high levels of testosterone levels to breast cancer in men is still not clearly justified. Some case studies and experiments might have pointed a finger in the direction of breast cancer caused by hormone replacement therapy in men, a clear study is yet to be framed to support the statement.
Testosterone Influence On Red Blood Cells
Testosterone affects the levels of haemoglobin by 6% to 7%, by effects on erythropoietin production. Which in turn can help in improving the symptoms of anaemia in men.
The studies which prove that polycythemia occurs as a negative side effect of testosterone therapy in men are very rare to find. With that being said, polycythemia is still a possible side effect caused by testosterone therapy. Testosterone can also have a positive effect on men, such as baseline anemia, 20% of men treated with testosterone therapy are also said to get caught in polycythemia. Polycythemia can also cause an increase in vascular event incidents, such as myocardial infarction, a stroke, or a possibility of deep vein thrombosis with the possibility of pulmonary embolus. These complications can be a possibility of polycythemia, but there is no clear demonstration of the occurrence of polycythemia in men being treated by TRT.
Due to the high risk of polycythemia, men who are being treated with TRT should get their blood count monitored during the process, and also have their doctors draw baseline CBC before the process of testosterone therapy begins. Hormone replacement therapy in men should also be stopped, if, during testosterone therapy, the level of hematocrit rises above 54%, and wait for hematocrit levels to normalize. After hematocrit levels normalize, the process can restart with frequent monitoring and lower doses.
Sleep Apnea And Testosterone Therapy
Objective sleep apnea, OSA, is another risk which is associated with male hormone replacement therapy of testosterone, but the cause of this condition is not very well cleared. On one hand, studies show that there is no clear coordination between objective sleep apnea and testosterone replacement therapy, while on the other hand, it has been seen that men going through male hormone replacement therapy face objective sleep apnea, and as soon as the process of TRT stop, the symptoms of OSA start to die down.
While the association of OSA with TRT is not cleared, men should always consult their doctors before opting for TRT therapy, the doctors can counsel the patient on the potential risk of OSA and other conditions. OSA symptoms, such as fatigue or snoring while sleep, should be monitored as well during the on-going process. The physicians might counsel patients out of getting TRT if they have already existing symptoms of OSA, as the symptoms can worsen during the process. For a clear picture on the association of OSA and TRT, there is the need for more research, for the purpose of clearance on its etiology.
Testosterone Effects On Body Habitus
TRT can be a cause for external and internal physical changes in men. Due to exogenous testosterone, an imbalance in the hypothalamus-pituitary axis can be caused. Estrogen of testosterone can be made possible by aromatization. Gynecomastia or breast pain can be resulted by an excess of estrogen, which are the symptoms that can be seen in 10% to 25% of men getting TRT therapy. The development of gynecomastia is not dependent on androgen increase itself, rather the ratio of estradiol to androgens. The evidence of a relationship between TRT and male breast cancer is only found in a few studies, other than that, the relationship between them is pretty unclear to this date.
Adding to that, visceral obesity can also be caused by the excess of estrogen. TRT can also promote weight loss, only if the serum estrogen levels are vigilantly monitored. The risk of edema or water retention is can be caused by TRT as well. To this date and time, the causes of this association are unclear. As already talked about, it is recommended to men bring treated with TRT to closely follow if they have a history of CHF.
Effects Of Testosterone On Different Parts Of The Body
The levels of the hormone of testosterone in a male’s body have different effects for different functions of the body such as sexuality, the reproductive system of a man to his bone muscle and bone density. It is normal for men to experience a low level of testosterone after the age of 30 or 40, but male hormone replacement therapy can have its fair share of effects on the body.
Endocrine System: The endocrine system of a body consists of are made of glands that produce hormones. Hypothalamus, which is located inside the brain, informs the pituitary gland of how much testosterone is needed by the body. After that, a message is sent to the testicles by the pituitary gland. Most of the testosterone in the male body is made in the testicles, but some of it comes from just above the kidneys, from adrenal glands. Testosterone starts working in a male body even to form male genitals, even before they are born. Later in the years of puberty, testosterone is responsible for the development of male characteristics such as a heavy voice, body hair and a beard or a moustache. The peak on testosterone levels in a male body is during the late teen years or early years of the twenties. After the age of 30, it is normal for men to see a decline in testosterone levels in the body, from the rate of about one percent every year.
Reproductive System: Seven weeks after conceiving a child, testosterone in a female’s body starts to help develop male genitals. During the years of puberty, the levels of testosterone in a male’s body peaks which helps in the growth of penis and testicles. The testicles are responsible for streamline production of testosterone, as well as make a fresh supply of sperm every day in a male’s body.
Men with low testosterone level can experience erectile dysfunction, ED. The production of sperm every day in a male body can decrease due to long-term testosterone replacement therapy. As well as, testosterone therapy can result in a large prostate and softer, smaller testicles for a man. Therefore, men who have been diagnosed with [rostate or breast cancer should not go for testosterone replacement therapy.