We all slow down a little as we age. Most of it is gradual, until you find yourself at a concert wishing they could turn it down just a smidgen—or you pull a muscle getting out of bed in the morning. For some men, low or non-existent sexual performance is the wake-up call that they’re not getting any younger, and things have been declining for some time.
Whether it’s a blow to the ego or you just want to get back to your lusty youth, many men are talking to their doctors about low testosterone (also known as “low T”) and whether hormone therapy (TRT, or testosterone replacement therapy) is right for them. Not only is it supposed to restore sexual functionality, but it could increase alertness, mental acuity, energy and relieve the symptoms of depression. Sounds great, right?
According to doctors, yes and no. Yes, testosterone replacement therapy can help men restore energy, sexual function and alertness, but there are risks associated with hormone therapy that may outweigh the benefits. It might sound like a miracle cure, but we don’t know enough about the long-term effects to prescribe it as soon as someone realizes their favorite band is now considered “dad rock.”
What testosterone does for the male body
Everyone has testosterone, regardless of sex, but testosterone is widely considered the “manly” hormone. Testosterone is produced by the testicles, ovaries and adrenal glands, and it regulates sexual function, bone density, fat distribution, facial and body hair and more. If you have low T, you may have trouble getting or sustaining an erection—which is upsetting enough on its own—but it can also result in depression, weight gain, muscle loss, disturbed sleep, trouble concentrating and a lack of physical energy.
If that weren’t enough, there are serious health risks from living with low T—namely osteoporosis. Since testosterone is responsible for sustaining bone density, weakened bones can make you more susceptible to injury and bone breakage as you age.
However, that doesn’t mean declining testosterone is necessarily something to worry about, especially if you’re on the younger side. Testosterone does decrease naturally as we age—about 1% per year, after age 30-40. However, if you have significantly lower levels than normal, you may have hypogonadism, which interferes with the body’s ability to produce the right amount of testosterone.
The risks of hormone therapy
Unfortunately, low T is a little more complicated than deciding to reverse the signs of aging by increasing your hormones. There is such thing as too much of a good hormone, and deciding to try testosterone replacement therapy comes with its own risk factors. If you’re considering it just because you’re feeling older—and not in a good way—be aware that it might not be the magic bullet you’re hoping for.
Risks include worsening sleep apnea and increasing prostate growth—and if you already have prostate cancer lurking, it will worsen that as well. Plus, you could deal with enlarged breasts and acne, limited sperm production and shrunken testicles.
Testosterone also regulates red blood cell production, so if your red blood cell count increases during TRT, your increase of forming a blood clot increases. Blood clots can be deadly when they break loose and travel to the lungs, causing a pulmonary embolism.
The risks can outweigh the benefits in many cases, so you may want to explore your options before deciding to try testosterone gel, injections or patches. Consider whether other health problems may be contributing to your symptoms, such as cardiovascular disease, depression and mood disorders, diet and exercise. Doctors suggest trying to adjust your work/life balance, make sure you’re eating fiber and protein-rich meals and going for quick bouts of exercise when you’re tired, to make sure the problem doesn’t lie elsewhere.
Should you ask your doctor about low T?
Just because there are risks associated with testosterone replacement therapy doesn’t mean it’s not a viable treatment for many men—it’s just that it may not be the miracle cure that pharmaceutical commercials make it seem. Some men will look at the risk factors and decide it’s not for them, while others will decide that sexual health, mood and bone density are important enough to live with the downsides. Whatever you decide, try to rule out all other causes first. If you don’t have to adjust your hormones, it may be best to leave it alone.