Testosterone Therapy for Men

Much like 30-40 years ago as estrogen replacement therapy was promoted for women in menopause, testosterone therapy for middle aged men is now all the rage.
But this is a definite situation of caveat emptor because much like estrogen therapy back then there is virtually no long term research on testosterone therapy's risks and benefits. Much of it's touted benefits are anecdotal and short term.
So here is the backstory.
Testosterone declines naturally with age, about 1% annually after you hit your mid-30's. This has an obvious impact on muscle mass, libido, and energy levels to name 3 prominent effects.
There also seems to be some evidence that men today have lower t-levels than their fathers and grandfathers due largely to higher obesity levels and exposure to environmental toxins.
Testosterone levels have decreased markedly in the last 20 years, some 16% in men age 65-69, for example. Obesity may play a role as body fat helps turn testosterone into estrogen.
Testosterone replacement therapy, or TRT for short, is like a gift wish list for every male: build muscle mass, trim fat, improve mood, increase energy, and improve sex drive. Who wouldn't want that?
That is why prescriptions for TRT have increased 500% over the last 18 years.
But there is a huge debate amongst the medical community about both it's efficacy and it's risks. And it won't be known for decades what those risks truly may be in the long term. We all know how the estrogen therapy picture changed once women had been using it for several decades: not as promising or safe as once thought.
There also is debate about what is a healthy level of testosterone. The current standard is 500-700 ng//dL for men under 40. Some proponents of TRT recommend those levels should be as high as 800-1,000 ng/dL.
But herein lies the rub. Some would maintain that there is a downside to high testosterone and that our bodies may lower levels as a protective mechanism against things like prostate cancer.
Studies on heart health and testosterone have been mixed to date. Some studies have shown higher levels correlating with lower heart disease mortality while some more recent studies have shown the opposite.
You also have to be aware of TRT's side effects: hair loss, shrunken testicles, acne, breast enlargement and even sterility. TRT can also raise hematocrit levels (red blood cell concentration) which is similar to blood doping and can raise the oxygen carrying capacity of the blood which is obviously a boon for endurance athletes. But at the same time if the hematocrit level gets too high the blood can become so viscous that it actually increases the risk of heart attack and stroke.
And TRT is lifelong therapy. Once you've started there is no going back as the brain starts to produce less testosterone itself.
So TRT is where HRT is for women 20-25 years ago. Initially, HRT was thought to be very safe but the outcomes some 20 years later have proven that not to necessarily be the case when it comes to some forms of cancer and heart disease.
So bottom line is to do your homework and research before considering TRT and exhaust all alternatives. It is a decison that ultimately can only be made by the individual but I would proceed with caution.

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