We have seen significant increases in the numbers of middle-aged and older men receiving a therapy to boost their levels of testosterone, even as we question its effectiveness and safety. Health Canada reports that Testosterone Replacement Therapy (TRT) has increased by 310 per cent in Ontario over the past 15 years — however, only about six per cent of men were actually diagnosed with a condition that would require TRT.
Testosterone is a hormone produced primarily in the testicles. It helps maintain men’s bone density, fat distribution, muscle strength and mass, facial and body hair, sex drive and sperm production. Testosterone levels generally peak during adolescence and early adulthood, then, starting around age 30 to 40, decline typically by about one per cent a year. The results from lower testosterone include less active libido, less vitality and reduced confidence and motivation.
TRT is most often prescribed for a condition called age-related hypogonadism, a condition in which the body has little or no ability to produce testosterone. If this is the cause of low levels of testosterone, TRT makes sense in most situations. It can mean a return of energy levels back to normal, a restored sex drive. There may also be a drop in body fat and a buildup of muscle mass. Great!
But there are also risks to TRT. These include more acne and oily skin, a reduction in sperm count, a higher risk for blood clots, shrinkage of the testicles, larger breasts and an increased risk of heart attack and stroke. There may also be an increase in sleep apnea. Research also suggests that testosterone therapy could stimulate the growth of prostate cancer cells.
In July 2014 Health Canada announced that it had completed a safety review on testosterone replacement products. They stated that there is “a growing body of evidence for serious and possible life-threatening heart and blood vessel problems such as heart attack, stroke, blood clot in the lungs or legs; and increased or irregular heart rate with the use of testosterone replacement products.”
As a result, Health Canada recommends that TRT should not be used in men for non-specific symptoms unless lab tests have confirmed a low testosterone level and that an assessment for cardiovascular disease is crucial before it is prescribed. In other words, before taking a chance on TRT, make sure the patient actually needs it and is not at elevated risk of heart disease.
For now, research is mixed on the safety and efficacy of testosterone replacement therapy with uncertainty over its long-term benefits and risks. Having said that, a medical condition that leads to an unusual decline in testosterone may be a reason to take supplemental testosterone. But if the changes are age related, TRT is not advisable currently.
Is testosterone replacement therapy right for you? Maybe, but before making any decision about your health, discuss the possible benefits with your doctor: do they outweigh the risks?
Written by Dr. Paul Martiquet, Medical Health Officer, Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.