Plenty of ads for testosterone supplementation or testosterone replacement therapy are only too happy to try selling you the dream: higher testosterone, better sex, enhanced libido, improved mood, smaller waistline, stronger muscles, more energy. One problem (and there are several) with this scenario is that while testosterone replacement therapy may raise your T levels, there is absolutely no guarantee it will help address any of the other issues typically associated with low testosterone. In fact, a recent report in Human Reproduction noted that “recent evidence has demonstrated that testosterone drugs do not substantially ameliorate these symptoms and…that their long-term use may be associated with severe adverse effects.”
It’s worth mentioning up front that testosterone replacement therapy is approved by the Food and Drug Administration for certain medical conditions only, including hypogonadism. In the vast majority of cases, however, men who are using testosterone supplementation are doing so off-label. Another issue is that men tend to believe testosterone supplementation is safe because it is natural. However, the only truly natural way to boost T levels is through lifestyle changes, including diet and exercise, some supplementation, and simple changes like getting enough sleep! In addition, there are two types of testosterone replacement—synthetic and bioidentical. The latter form of T supplementation is considered to be safer than the synthetic approach, but side effects are still possible.
Promises of testosterone replacement therapy
Let’s take a closer look at the promises associated with testosterone replacement therapy. First, can it boost your T levels? Research indicates that it can, but so can placebo, and without the risk of side effects. For example, in a clinical study of 274 men who had low testosterone, half took a testosterone replacement product (AndroGel 1.62%) daily for 16 weeks while the other half took a placebo. By the end of the study, testosterone levels had returned to “normal” in 82 percent of those who took the supplement, but it also reached healthy levels in 37 percent of men who took the placebo.
Testosterone replacement therapy and sexual function
Use of testosterone replacement therapy may increase your sexual function but only if you truly have abnormally low T and your sex drive is low as well. In a German study, the authors noted that men with hypogonadism who took supplemental testosterone experienced a mild positive effect on sexual functioning from taking the hormone. However, in men with normal T levels, supplementation does not appear to have much of an impact on sexual function.
For example, a review appearing in the Journal of the American Geriatrics Society article reported that based on their findings, “testosterone supplementation cannot be recommended at this time for older men with normal or low-normal testosterone levels and no clinical manifestations of hypogonadism.” One reason for this response may be that when the body is given testosterone, it transforms some of it to estrogen, and higher levels of this hormone may cause a reduction in sex drive, which is opposite of the desired result.
Testosterone replacement therapy, addiction and infertility
Once you start taking testosterone supplements, it is possible you will need to continue taking them for the rest of your life. That’s because use of supplemental T causes your testicles to shrink and your natural production of the hormone to cease—sometimes temporarily or sometimes permanently, depending on how long you have been taking the hormone. Essentially, choosing to take testosterone replacement may result in your making a deal with the devil—and having to shell out hundreds of dollars every month for the rest of your life. If you choose to boost your T levels naturally with lifestyle changes, however, you can avoid these challenges.
Another negative concerning testosterone replacement is a decline in sperm production, which in turn decreases fertility. For many older men, this is not an issue. However, if fatherhood is on your wish list, then you need to reconsider your use of T replacement.
Testosterone replacement, mood and cognition
Studies of the impact of testosterone replacement on mood have yielded mixed results. However, in a new review from Johns Hopkins University School of Medicine, the authors concluded that “Overall, available data are not suggestive of a clear benefit of testosterone supplementation in multiple domains of cognition and in mood.” A 2008 review also noted that most research does “not support testosterone as a broadly effective antidepressant,” and that there is “little support for a pervasive influence of testosterone on mood.”
Testosterone replacement therapy and muscle strength
It’s a common belief that testosterone supplementation increases muscle mass, but some of the research findings are inconclusive. A review in 2003, for example, reported that a link between testosterone and strength was not conclusive. Even if testosterone does allow men to add a few extra pounds of muscle bulk, strength is acquired through training, not solely the presence of bulk.
Testosterone replacement and other issues
Although evidence indicates that testosterone therapy doesn’t cause prostate cancer, there is some research showing it may speed up the growth of an existing prostate cancer or make it worse. Another issue to consider regarding testosterone replacement is that you need to keep it away from women and children because their contact with it can result in unwanted hair growth.
Let’s not forget the side effects associated with the use of T replacement. In addition to the challenges already noted, the side effect list includes development of acne, sleep apnea, heart failure, hair loss, liver problems, breast growth, increased risk of heart disease, worsening of urinary tract symptoms, and blood clots. Approximately 40 percent of men who take testosterone replacement develop polycythemia, a condition in which the blood cell count rises and thickens the blood. This in turn can raise your risk of stroke, blood clots, and heart attack.
On a final note, testosterone replacement therapy has not been studied long-term, so there is still much we don’t know about the eventual development of side effects. Basically, at least for the time being, use of supplemental testosterone can be beneficial for men who have been diagnosed with clinical hypogonadism (low T levels and symptoms), but for other men it’s a huge mistake, especially since some doctors are prescribing it without even testing a man’s T levels and based solely on hearing about vague symptoms, such as low sex drive or low energy.
Amiaz R, Seidman SN. Testosterone and depression in men. Current Opinion in Endocrinology, Diabetes and Obesity 2008 Jun; 15(3): 278-83
Busnelli A et al. Forever Young—Testosterone replacement therapy: a blockbuster drug despite flabby evidence and broken promises. Human Reproduction 2017 Apr 1; 32(4): 719-24
Gruenewald PA, Matsumoto AM. Testosterone supplementation therapy for older men: potential benefits and risks. Journal of the American Geriatrics Society 2003 Jan; 51(1): 101-15
Kaufman JM et al. Efficacy and safety study of 1.62% testosterone gel for the treatment of hypogonadal men. Journal of Sexual Medicine 2011; 8(7):2079-89.
Saad F et al. Testosterone deficiency and testosterone treatment in older men. Gerontology 2017;63:144-156
Yalamanchi S, Dobs A. Debate position: cognition and mood are not improved in men administered exogenous testosterone therapy. Current Opinion in Urology 2017 Nov; 27(6): 525-31