It’s a hard pill to swallow: The same hormone that’s lauded for its ability to maximize strength, sex drive, energy levels, and overall life satisfaction is also the one that steadily declines as you age. So it’s no wonder that interest in testosterone replacement therapy is reaching an all-time high.
But before diving head-first into any form of hormone optimization, you’ll want to do your homework. That’s why we tapped Dr. Vinita Tandon, Lifeforce’s Medical Director, a board certified endocrinologist, and previous national medical director for 12 hormone optimization clinics, to help us separate fact from fiction.
Is it safe? Is it effective? Yes and yes, but it needs to be done right and with the right clinical oversight, says Dr. Tandon. (Check out how Lifeforce approaches hormone optimization here.)
Read on for eight common beliefs about TRT, and whether they’re true with a capital T…or completely false.
Testosterone Replacement Therapy: Fact or Fiction?
1. Testosterone replacement therapy can wait 'til your 50s.
Fiction. There's no need to suffer through every symptom in the book, says Dr. Tandon. (We're talking low libido, waning energy, reduced muscle mass, poor sleep, mood, confidence, and more.) Since testosterone levels begin to drop 1-2% each year starting at age 35, it's a good idea to start measuring your baseline around that time. The Lifeforce Diagnostic is one way to get a clear picture of your hormone levels, along with a Lifeforce clinician who will interpret your results and put together your personalized performance plan.
2. Testosterone therapy can increase your prostate cancer risk.
Fiction. No study or trial has definitively demonstrated that testosterone therapy is an independent risk factor for developing prostate cancer, according to Dr. Tandon. For an abundance of caution, we test our members’ prostate-specific antigen (PSA) levels as part of their diagnostic labs and routinely while on testosterone treatment. (PSA levels can be elevated in men with prostate cancer, according to the National Cancer Institute.)
3. Testosterone therapy affects fertility.
Fact. Men taking exogenous testosterone may experience a decrease in sperm count as the body down-regulates whatever natural testosterone production is still occurring to accommodate the increased external supply, Dr. Tandon explains. Although this decrease is usually temporary, for men who want to preserve their fertility, we would recommend other treatment options. Some options include Clomiphene, a pharmaceutical which can help improve your innate testosterone production, testosterone boosting supplements, or lifestyle changes.
4. Testosterone therapy can up your risk for cardiovascular issues.
Fiction. Many studies have refuted this idea, Dr. Tandon says, although most research in this space has thus far been too short or not powerful enough, resulting in conflicting findings, according to a review in the journal Nature Reviews Cardiology. The authors report that a trial of testosterone therapy, called the TRAVERSE trial, started in 2018 but the results may not be available for a decade.
“If anything, by improving your body composition and metabolism through testosterone therapy, you often reduce your cardiovascular risks because your LDL [“bad” cholesterol] starts to go down and your blood pressure improves,” Dr. Tandon says. In fact, the same review suggests that having low levels of endogenous testosterone is a risk factor for cardiovascular events.
A valuable marker of general health and safety, lipoprotein (a) (LPa) is included in our blood tests as a strong indicator of overall cardiovascular risk.
5. Testosterone injections are the only delivery method that works.
Fiction. Many men on testosterone optimization treatment use creams and get excellent results. The cream versus injectable decision is based on individual preference, lifestyle factors, and judgement of the prescribing doctor. Creams, for example, have a slight risk of transference so if a man has young children at home, injection may be a safer bet.
6. Testosterone can shrink your testes.
Fact. Dr. Tandon says that although testicular shrinkage can happen, it’s unlikely it would be by more than 10%. “Most men don't notice it much,” she adds.
7. Testosterone can give you man-boobs.
Fact. “When you use exogenous testosterone, a little bit converts to estradiol, one of the estrogens,” Dr. Tandon explains. “If there's too much of that conversion, some men develop a little breast tissue and/or tenderness.” The thing is, some estradiol is good — it helps reduce belly fat and promotes bone mass, she adds.
There’s a simple fix, though: An aromatase-inhibitor (aromatase is an enzyme that facilitates the biosynthesis of estrogens) called Anastrozole helps block that conversion, Dr. Tandon says. The team at Lifeforce will help you strike the right balance so you’re getting enough — but not too much — estradiol.
8. Testosterone can give you acne.
Fact. Testosterone ups the production of sebum, which can inflame hair follicles on the face, potentially resulting in acne. In fact, studies show that acne patients produce higher levels of testosterone, so it makes sense that upping your testosterone levels might lead to acne. However, this is also an easy solve: Your Lifeforce practitioner will keep tabs on any side effects, like acne, and help adjust your protocol accordingly.
Want to read more about hormone optimization for men? Check out what every man over 30 needs to know about testosterone optimization in this comprehensive guide.
This article was medically reviewed by Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism.
Originally published on May 7, 2022. Updated on June 4, 2024.