The Problems with Testosterone Replacement Therapies
Medically reviewed by Leann Poston, M.D. on 9/28/20
As most men know, their primary sex hormone is called testosterone. It’s responsible for sexual differentiation into a male during gestation and continues to play an important role throughout life. Testosterone triggers male genital growth and development, as well as other bodily changes during puberty. Throughout adult life, it is a critical component in male sex drive. It also plays roles in energy levels, muscle development and maintenance, hair growth and loss, and many other processes throughout the male body. Women have some testosterone, too, though at levels far less than in men.
Typically, testosterone levels in men are variable, though there is a range that is considered “normal”. Testosterone levels tend to peak in men after puberty, up until their 30s. Sometimes in their 30s, most men start to see their overall average testosterone level decrease slowly over time. This decrease is on the order of around 1% per year or 10% per decade (Feldman et al, 2002). While this doesn’t sound like much, it adds up – especially if you started on the lower end of the “normal” spectrum.
The effects of this decrease in testosterone can be seen in the increased rate of erectile dysfunction, loss or decrease in sex drive, difficulty in reaching orgasm, and other negative sexual health outcomes, which tend to increase as men get older. In recent years, testosterone replacement therapy has been put forward for this age-related decrease. By replacing some of the lost testosterone, the theory goes, levels increase, and these ill effects can be reversed. While testosterone therapy does work, numerous negative health consequences are possible as well. Further, it is not always a prescribed solution for age-associated testosterone changes, and more aimed at those who have medical conditions that artificially lower their testosterone.
Let’s take a further look at testosterone replacement therapy, starting with the basics, so that we can appreciate the potential problems with embracing it for age-related testosterone loss. We’ll also mention some of the alternative options that are available, and generally far safer and easier to obtain.
Aging-Associated Testosterone Changes vs. Abnormally Low Testosterone
First, it’s important to distinguish between the different kinds of testosterone changes or loss that exist. “Low T” as it is sometimes known refers to abnormally low testosterone levels in otherwise healthy individuals, whose levels should be higher. This is not typically synonymous with age-associated testosterone loss. Rather, it’s either idiopathic (unknown origin or cause) in nature, or the result of medical conditions. For example, certain medicines and medical conditions can cause dramatically reduced levels of testosterone in the body. These are the kinds of situations that most doctors use as a criteria for prescribing testosterone replacement therapy.
On the other hand, you have normal aging-related testosterone decrease. The rate varies from individual to individual, of course, but it is normal to have less testosterone as you age, which progressively decreases. Most often, it is difficult to find a doctor willing to prescribe testosterone replacement therapy in these cases, absent certain other underlying conditions (e.g. erectile dysfunction). Even then, it’s not the first choice of treatment for most medical professionals, due to the myriad risks and side effects, as we’ll explore later in this article.
Despite the fact that testosterone levels decrease with age, and that it is a normal process, that doesn’t mean that men have to accept it. There are ways to treat decreased testosterone due to age, that don’t rely on testosterone replacement therapy, as we’ll discuss at the end of this guide.
Typical Types of Testosterone Replacement Therapies
For those who are prescribed testosterone replacement therapy for low testosterone, it typically comes in a few different forms. Each has different pros and cons associated with them, and typically your doctor will prescribe the form that makes the most sense given your health history, the purpose of the treatment, and treatment objectives. The most common types of testosterone replacement therapies include:
- Testosterone patches, which are applied to the skin and changed periodically, delivering medicine through the skin. They work similar to anti-smoking patches or birth control patches in that sense.
- Buccal patches, which are a type of patch designed to be applied to the gums or cheeks, rather than the external skin. They do work like skin patches, however, but have lower levels of active ingredients due to the greater bloodstream absorption power of the gums over the skin.
- Gels, applied topically to certain areas of the body (often the upper arm or shoulder region). They are usually applied daily. Over the course of a day, they are absorbed into the body through the skin.
- Subcutaneous pellets, essentially small pill-like pellets that are placed under the skin by a doctor in a minor surgical procedure every 3 to 6 months. They break down over time and are absorbed into the body, providing a steady stream of the medication.
- Injections, which are usually administered every few weeks or months, depending on the strength and formulation.
This article isn’t a comprehensive guide to testosterone replacement therapies, and there are particular benefits and risks associated with each of these different types of therapies. Rather than get into too much detail, however, we’re looking at the general risks of all types of testosterone replacement therapies, especially in comparison to some of the safer alternatives that are available. Still, plenty of medical studies and data exists on the risks of certain varieties of this therapy, in addition to the overall risks – for example, this study and this study. We’ll talk about some of the risks and problems of testosterone replacement therapies, in a general sense, in far more detail below.
Goals and Benefits of Testosterone Replacement Therapies
The primary purpose of testosterone replacement therapy is right there in the name – it is designed to replace and restore testosterone levels in the patient. By most measures, this means returning testosterone levels to what is concerned a normal male baseline range for the age of the man in question. In some circles, it includes boosting testosterone levels in older men back to levels that were normal for a 30-something man, though this is not universally agreed upon by many doctors and practitioners.
Typically, the rationale for restoring testosterone levels is to offset unnaturally low levels, and thus returning someone’s hormone levels to where they should be at that age. Because testosterone plays such an important role in the body, this translates into benefits including:
- Restoring sexual function and desire/sex drive.
- Increasing energy levels and stamina (not just in terms of sex).
- Decreasing body fat and aiding weight loss.
- Increasing lean muscle mass and making it easier to gain and maintain new muscle.
- Improving energy metabolism.
- Treating erectile and sexual dysfunction.
- Treating facial and body hair loss.
- Addressing the attendant depression and other mental health effects that can result from low testosterone levels (Bassil et al., 2009).
Many of these benefits overlap with the goals of men seeking to boost their testosterone levels due to age-related losses. There is no doubt that many of these benefits can be realized through a proper, well-managed course of testosterone replacement therapy, as well as through other alternative treatments. However, there is a serious set of problems in doing so: testosterone replacement therapy comes with a lot of risks and possible side effects.
Risks of Testosterone Replacement Therapies
Fairly universally, it is recommended that if you currently have, or have previously had, prostate or breast cancer, then testosterone replacement therapy should be avoided, due to unacceptable health risks. These risks can include cancer recurrence or the development of cancer in other parts of the body. Some evidence shows that men who have successfully beaten prostate cancer may be able to receive testosterone replacement therapy, but the jury is still out on that particular risk/reward scenario (Osterberg et al., 2014).
Other conditions that may be too risky or result in caution advised by a doctor before beginning testosterone replacement therapy include:
- Sleep apnea, particularly the obstructive variety, may be made worse (resulting in possibly fatal breathing stoppage) in those undergoing testosterone replacement therapy.
- Prostate-related symptoms, such as enlargement or BPH, can be exacerbated and cause urinary tract symptoms when combined with testosterone therapy.
- Congestive heart failure is a contraindication for testosterone replacement therapy.
- Higher than normal red blood cell counts also generally a contraindication for therapy.
Possible Side Effects
In addition to the risks and contraindications mentioned above, there are several well-known and widely-experienced side effects associated with testosterone replacement therapy. Some are minor inconveniences, while others may be considered life-threatening in some cases. Specifically, the most common side effects include:
- Increases in pimples and acne, the emergence of acne, and increased levels of oily skin.
- Increased risk of blood clots, especially in those with high blood pressure or existing clotting disorders.
- Reduced sperm count, leading to or contributing to infertility.
- Reduction in size or shrinking of the testicles.
- Gynecomastia, or an unnatural enlargement of male breasts.
- Increased risk of heart attack, stroke, and other cardiovascular problems (Bassil et al., 2009).
On top of those side effects, certain types or methods of delivery for testosterone replacement therapy have their own additional risks, or risks for others who may interact with the individual undergoing treatment. For example, the gel type testosterone replacement therapy comes with a standard caution that others, especially women, should not touch the areas to which the gel is applied (or the gel itself) for a number of hours after application. Otherwise, they may inadvertently be exposed to and absorb testosterone, resulting in ill health effects. This also applies to children, where it may cause early puberty and other unhealthy symptoms. Therefore, in these circumstances, the specific type of therapy used also needs to be thoroughly considered for the additional risks it can present.
Overall Physical and Psychological Health Needs to be Addressed
While testosterone replacement therapy is a proven treatment for low testosterone, it is not typically prescribed for age-related testosterone loss. Even if you are prescribed it for that purpose, other physical and psychological health needs often need to be addressed and may be associated with aging, in order to regain full sex drive and functional satisfaction. Testosterone is not the only hormone or chemical in the body that governs things like feelings of well-being, arousal, erectile function, energy, metabolism, and so on. In addition, no therapy or medical treatment can, on its own, address problems like obesity, other medical or health problems, depression or mental health issues, or relationship issues. All of these aspects of your life, especially as they relate to age-induced changes, need to be addressed – regardless of whether or not you obtain testosterone replacement therapy.
Safer Medication Alternatives
For many men, there are safer medication alternatives to traditional testosterone replacement therapy. These not only have fewer risks, contraindications, and side effects, but can help to address those other overall physical and psychological health needs we just discussed above. There are two primary categories of these safer alternatives: supplements and non-testosterone treatments.
Supplements include a range of herbal and artificial compounds marketed to increase sex drive, reverse erectile dysfunction, increase energy and metabolism, and similar effects. Some have decent science behind them, whereas others are no better than snake oil. Most of these supplements are not regulated by the FDA as medications, and not held to any kind of standard for efficacy. Therefore, it’s a bit of a crap shoot as to whether or not they will work for any individual man. Likewise with the side effects – though in most cases, the side effects are far fewer and far less severe than the known side effects of testosterone replacement therapy.
On the other hand, there’s a middle ground that seems to be the most beneficial for most aging men: non-testosterone treatments. One of the leading medications in this field is CJC-1295. CJC-1295 isn’t a hormone itself – it’s designed to stimulate the natural production of hormones in the body. It doesn’t stimulate testosterone production but instead triggers the production of human growth hormone from the pituitary gland. Because your body is producing its own natural growth hormone, there are far fewer side effects and risks as compared to injecting artificial hormones.
At the same time, because it is not solely a testosterone equivalent, it is far more effective at addressing overall age-related health changes. This includes boosts to energy level, metabolism, lean muscle mass, body fat percentage reduction, improved cellular regeneration and repair, strength, and stamina – on top of libido and sexual function. It’s an exciting treatment that is both effective and affordable, with a much greater safety level for the average adult male than testosterone replacement therapies. Learn more about CJC-1295, or have a consultation with a medical expert who can write you a prescription, if you are a good candidate for the medication, and fulfill your order, by visiting Invigor Medical’s website.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
- Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002;87:589–98.
- Grech, A., Breck, J., & Heidelbaugh, J. (2014). Adverse effects of testosterone replacement therapy: an update on the evidence and controversy. Therapeutic advances in drug safety, 5(5), 190–200. https://doi.org/10.1177/2042098614548680
- Osterberg, E. C., Bernie, A. M., & Ramasamy, R. (2014). Risks of testosterone replacement therapy in men. Indian journal of urology : IJU : journal of the Urological Society of India, 30(1), 2–7. https://doi.org/10.4103/0970-1591.124197
- Bassil, N., Alkaade, S., & Morley, J. E. (2009). The benefits and risks of testosterone replacement therapy: a review. Therapeutics and clinical risk management, 5(3), 427–448. https://doi.org/10.2147/tcrm.s3025