Potential Testosterone Replacement Therapy Side Effects -- By Dr. Stephen Stevenson
There is a long list of potential side effects that can go along with testosterone replacement therapy (as I mentioned in my previous blog). Most side effects are fairly uncommon, but a few occur frequently enough that they warrant discussion.
Far and away the most common side effect of Testosterone Replacement Therapy (TRT) is loss of testicular volume, which is associated with decreased fertility. With therapeutic TRT there is a generally 10–20% loss in testosterone volume, but in body builders drawing on extremely high doses of testosterone the loss of testicular volume can be upwards of 90%.
An outside source of testosterone creates a negative feedback on the body’s own testosterone production, that is, the body ceases producing its own testosterone. The higher the dose, the more significant the decrease in testicular volume and fertility. When TRT is given for a relatively short period of time these changes are usually reversible. If TRT is given for a more extended period of time, such as over the course of one or more years, these changes can be irreversible.
Although this particular side effect occurs in most men that take TRT, there are some work-arounds that can be effective. One strategy involves taking an additional prescription medication, human chorionic gonadotropin (hCG), that stimulates the body to produce testosterone, and is frequently used to treat infertility.
“If hCG can be used to increase testosterone production, why not just use hCG instead of TRT to raise low testosterone levels?” you may ask. Occasionally, hCG alone will be enough to increase testosterone levels to the degree where clinical symptoms of low testosterone improve. However, most of the time this is not the case. So rather than replacing TRT, hCG is generally used to augment it and prevent testicular shrinkage as well as infertility. HCG is taken by subcutaneous injection, similar to an insulin shot, and it is usually dosed either daily or every other day.
Another potential work-around is to cycle TRT. This involves taking TRT for a set period of time, generally several months, followed by a similar period off of TRT. An obvious disadvantage of this work-around is that the symptoms of low testosterone generally recur during the time off of TRT. To most men, having symptoms of low testosterone half of the time is not acceptable.
During the three years that I exclusively treated men with low testosterone, I found that most of the men I treated were middle-aged, not concerned about losing fertility, and therefore willing to accept the loss of testicular volume. They were not interested in the additional expense and injections associated with hCG supplementation or the recurrence of their clinical symptoms that goes along with TRT cycling. They generally felt that the benefits they got from TRT more than offset the common side effects.
Another potential side effect of TRT is an elevation of estrogen levels. This side effect does not occur nearly as often as loss of testicular volume and infertility and I will discuss this and some of the work-arounds for it in my next blog.
Come see Dr. Stevenson for your health needs at Atma Clinic (first visit is free). Contact us today at 785/760-0695 to set up your appointment.