Side Effects of Testosterone Replacement Therapy (TRT)
As with any other medical treatment, side effects can occur. Fortunately with testosterone replacement therapy (TRT) though, side effects are generally rare and when they do occur, they are easily manageable with an experienced and knowledgeable medical provider on board. This is why here at True North Health & Wellness, we optimize your well-being, which includes minimizing side effects and treating them promptly when they occur through routine lab work and thorough evaluation.
When a man begins TRT, he is giving himself exogenous (outside of the body) testosterone. Generally speaking, a man’s levels are low when therapy begins and the body can become “overwhelmed” with these new found testosterone levels. This usually only occurs when the levels are to high or the body over metabolizes the testosterone.
When testosterone is metabolized in the body, it is broken down into dihydrotestosterone (DHT) and estradiol (E2, an estrogen). These two hormones are responsible for the vast majority of common side effects when a man is undergoing TRT.
When DHT levels are elevated, men can experience an increase in acne, oily skin, benign growth of the prostate, and male pattern balding (this is rare and usually the male has a genetic predisposition towards balding). Ever wonder why teenage boys have oily skin and develop acne? Its because of the surges of testosterone that occur during puberty. Again, these side effects are rare and can be easily managed through decreasing the testosterone dose, creams, or changing diet.
On the other hand, when E2 increases, symptoms can include mood swings, breast puffiness, fluid retention, decreased libido, and erectile dysfunction. Many men are walking around with high estrogen levels and don’t even realize it! Everyone has heard the term “man boobs” before and it is usually chalked up to aging and getting fat, when in fact high estrogen levels are to blame. Thus, it is critical to keep estrogen levels in check during TRT to minimize and prevent these bothersome side effects. This is a standard procedure at True North Health & Wellness and all men’s estrogen levels will be carefully followed and managed during treatment.
A common fear among men who might have done research on TRT is the risk of prostate cancer. Testosterone can cause the prostate to increase in size in some men, but again, this is a rare side effect and benign in nature. In terms of prostate cancer, study after study have demonstrated that TRT does not increase the risk of prostate cancer. In fact, recent studies are now showing that low testosterone is associated with an increased risk of prostate cancer. Regardless, before and during treatment, a man’s prostate specific antigen (PSA) will be monitored to ensure there are no significant changes occurring to the prostate during treatment.
The use of exogenous testosterone also can cause infertility (low sperm count). Testosterone and sperm production are controlled by the Hypothalamus-Pituitary-Gonadal Axis. The hypothalamus produces gonadotropin releasing hormone (GnRH) that tells the pituitary gland to release both luteinizing hormone (LH) and follicular stimulating hormone (FSH) that travels to the testicles which then produce testosterone and sperm.
When exogenous testosterone is introduced to the body, the increased levels are sensed by the brain and thus the production of GnRH decreases. This results in decreased secretion of both LH and FSH which in turn results in a drop of testosterone and sperm production by the testicles. In many men, the reason they have low testosterone is because of dysfunction within this process. During TRT though, this happens due to treatment and can result in temporary infertility. This might be a welcomed side effect by many men, but to those wishing to maintain fertility, it can be alarming. This side effect is easily prevented by the addition of hCG to the treatment protocol.
Additional common side effects include thickening of your blood via a process called erythrocytosis. This is when the body produces more red blood cells. We check your hematocrit levels throughout treatment to monitor for this. In the past, common treatment was if your hematocrit level is over 54%, we would recommend you donate blood to drive the percentage down. However, more recent studies are showing that this may not necessarily be best practice. Many factors such as hydration can affect the hematocrit levels and they can fluctuate. It is believed that your body will naturally regulate your levels and current practice is to monitor and treat if necessary.
Other side effects include a small decrease in your HDL (good cholesterol), increases in body hair, deepening of the voice, and increased sex drive. All of these will be monitored for and addressed if they occur.
Adverse reactions of testosterone optimization therapy are typically self limiting and rare. Most men tolerate treatment without issue but when problems occur, they are easily managed through careful monitoring and early intervention. Our goal at True North Health & Wellness is to optimize your health and well being throughout all phases of treatment. If you are interested in exploring testosterone optimization, schedule your online consultation today!