Testosterone Therapy: The Good, the Bad & the Ugly

I get asked all the time … “Is testosterone therapy safe?”

To which I answer, “Yes … but not always … and only if your doctor knows what he’s doing.

Not much of an answer, I know. The truth is that for the vast majority of guys, testosterone therapy is not only safe, but can actually improve health.

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The Good

For guys who have low testosterone levels, testosterone therapy can have tremendous benefits. Guys undergoing testosterone therapy can see improvements in muscle mass, bone density, heart health, libido, sexual function, mood, energy and motivation.

Some men are actually able to discontinue their anti-depressants (under their doctor’s care) once they start testosterone therapy. They improve their motivation, memory and cognitive function so much that their careers get a giant boost and they earn substantially more money.

They lose the depression and irritability that has impacted their interactions with their wife, family and friends, and their relationships improve and deepen.

Some guys regain the sexual vitality they thought was gone forever. Their marriage and sex life improve beyond recognition.

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There is, however, a tiny minority of men for whom testosterone therapy can be not only dangerous, but in very rare instances, fatal.

So let’s talk about The Bad and The Ugly.

Prostate or breast cancer

While starting testosterone therapy won’t cause prostate or breast cancer, in men whose testosterone levels have been medically lowered as part of their treatment for pre-existing prostate/breast cancer, changing their testosterone levels can cause already occurring cancer cells to re-grow. So, if you are currently being treated for prostate or breast cancer, testosterone therapy is probably not a good option for you. Good article about testosterone and prostate cancer.

However, men with low testosterone levels are actually at higher risk for prostate cancer, so keeping your testosterone levels optimal can lower your risk for prostate cancer.

A doctor who knows what he’s doing will administer both a DRE (Digital Rectal Exam) and PSA (Prostate Specific Antigen) test to rule out any pre-existing prostate cancer prior to starting testosterone therapy. Incidentally, these are both good tests to do periodically even if you’re not starting testosterone therapy.

Heart Problems

This is another of those paradoxes where guys who have low testosterone levels are at higher risk for heart disease, but if you already have pre-existing heart disease, then testosterone therapy can be a problem, especially if not administered correctly.

Testosterone therapy tends to raise not only your testosterone levels, but also your estrogen levels and your red blood cells. Both of these can be issues for heart health. An experienced specialist will monitor both your estrogen levels and your red blood cell counts to make sure they stay within optimal limits. If your estrogen increases too much, the doctor will prescribe a med (aromatase inhibitor) to lower the estrogen and will likely suggest you donate blood to keep your red blood cell count within optimal levels. Article about the heart benefits of testosterone therapy.

Blood Clots and Strokes

For most men, testosterone therapy is safe, but if you are in the estimated 1-2% of men taking testosterone therapy who has an inherited blood clotting disorder, T therapy could actually cause a disabling or even fatal stroke. Fortunately, there are simple blood tests to rule this out, available with your other blood work at your regular lab and routinely covered by health insurance. However, you need a doctor who knows enough to request it. It’s really important to do these tests because many people with clotting disorders have no idea that they have one.

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So there you have it … The Good, The Bad and The Ugly. 

Like any other medical treatment, T therapy has risks and benefits. The biggest take-away I hope you get from this blog post is that the single, most important, absolutely vital, #1 part of getting testosterone therapy is finding a doctor who has specific training in administering testosterone therapy. Don’t assume that your GP, urologist, endocrinologist or holistic doctor knows what he’s doing. You need a doctor with specialized experience in treating low testosterone.

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And just because this is a cool video and so you’ll have this song stuck in your head the rest of the day …