Testosterone (HRT / TRT): Some Pros and Cons

Testosterone: The Pros and ConsGoing on HRT (Testosterone Therapy) is a big decision. Many men cannot wait to get on it, because they are so miserable with low testosterone. Still other men are fearful of it and concerned that they may be making a dangerous choice from which they cannot turn back. I certainly would not try to persuade you one way or the other, but I would like to bring up some of the many apsects, both positive and negative, of HRT that are counterinutitive in many cases and largely unknown in still others. I have been through four different delivery systems and three doctors before I finally found testosterone replacement that really helped on a consistent basis. And I’ve picked up many of the pros and cons along the way that you might not hear about, especially when you are first starting out in the decision making process.

THE PROS OF TESTOSTERONE THERAPY:1) Diabetes Cure. As I discuss in my link on Testosterone and Diabetes, almost all of the (type II) diabetic men that go to the HRT clinic where I go have gotten off of their insulin. This, of course, is because testosterone has such a powerful insulin-lowering effect and improves insulin sensitivity. Now you do have to keep in mind that these men will start with testosterone below 450 ng/dl generally and have their average testosterone taken up near 850 or 900 ng/dl. This is a little higher average testosterone than a diabetic man would typicall recieve in the office of a PCP or even urologist. Nevertheless, almost any man will get a substantial benefit in the area of insulin and blood sugar control.  Many men with Metabolic Syndrome (prediabetes) will also likely be greatly relieved as well.

2)  Libido. HRT is simply king at increasing libido and passion for life in general.  None of the other testosterone-raising strategies such as Clomid or HCG Monotherapy has the consistency and dose dependence in increasing sexual desire.  Most men, from what I have seen, get some kind of libido boost.  And many men will go from “I don’t even care about sex” to “I am chasing my wife/girlfriend around the bedroom”.  (There are no guarantees however.)

4) Caring.  It is very common for low T men to say that they feel like a “zombie” and care about nothing in life.  Testosterone very often changes all that.  Suddenly, a man will say that he actually cares about life and career again.  Women pick up on this as you suddenly care about her and all aspects of daily life once again..

CAUTION:  Some men write in after a few months of testosterone therapy and ask, “When will I feel anything?”  Not everyone has a dramatic experience with HRT.

6) Improved Physique.  Testosterone will usuall improve your body composition in many ways:  a variety of studies have shown that it builds muscle, lowers fat and can even fight deadly visceral fat.  The most common comment I get from men on the Peak Testosterone Forum about HRT and the body, though, is that it helps their recovery time at the gym. Basically, the perception is that they are able to lift more and lift harder.  I have heard that it is very common for men on HRT to have a variety of aches and pains.  Why?  Because they now have increased energy, passion and alertness for exercising at the gym and sometimes they overdo it!

THE CONS OF TESTOSTERONE THERAPY:We’re going to cover some of the cons that you might not normally think of.  What I’m not going to cover is poorly executed HRT that does no monitor estradiol.  If a man’s testosterone is pushed high enough by his HRT, then his estradiol will go up due to aromatization.  And the older and/or more overweight you are, the greater your estradiol levels on average.  The symptoms of high estradiol include gynocomastia, water retention/”bloating”, low libido and erectile dysfunction.  Many unsuccessful HRT experiences are simply due to doctor ignorance and reflect the fact that estradiol is not monitored.  This is very unfortunate, because high estradiol is just as bad as low testosterone for most men.

1) Testicular Volume.  If you go high enough with HRT, you may lose a little weight in your testes as production is shut down.  This is usually minimal, but some men notice it and feel very insecure about it.  I seriously doubt that the great majority of women out there would notice even if this does occur, but the important thing is that if you lose confidence, it may affect your life in the bedroom.  So you have to weigh your options:

a) Go lower with your testosterone dosage.  Anything less than 600 is unlikely to change your testes appreciably.  (Talk to your doctor though.)

b) Ignore the issue.

c) Take HCG.  (This can boost mood and libido for some men besides preserve testicular volume.)  See my link on Testosterone and HCG for more information.

2) Acne.  Occasionally a man will develop acne.  For example, one man wrote into the Forum and said, “Just got back from seeing a dermatologist. He tells me “my acne is caused by testosterone, and there is nothing that Can be done to get rid of it. Every guy on T has the same problem” I need some help on how to get rid of this! If there is a way I’m certain someone here has the answer! It mainly located on my chest stomach and back.” [1] Of course, I completely disagree with the doctor’s assertion that every guy on HRT has acne.  In fact, it is more the exception from what I have seen.  However, it can occur and then must be treated just like your teenagers might get treated.

3) Fertility.  Many young men never think about the fact that if they go on HRT, their fertility will likely be strongly impaired.  There are options around this such as adding HCG into your regimen.  But that can more time and money and, from what I understand, does not always work. So talk to a fertility specialist if this might be an issue for your situation.

4) High Converter to DHT (Enlarged Prostate and/or Hair Loss).  Some men seem to convert more of their testosterone to DHT (dihydrotestosterone) and this can lead to enlarged prostate and/or accelerated hair loss.  Now I have never had anyone on the Forum complain of this that I remember, but it certainly is reported.  And the medicaitons to treat hair loss can anhilate permanently your testosterone.  (See my link on Properica Risks for more information.) And finding that you have an enlarged prostate could be problematic, because urologists will usually employ alpha blockers or daily Cialis to battle BPH and, of course, both are pharmaceuticals.  So you basically will probably have to either go off testosterone or take a pharmaceutical in order to deal with this.

5) Elevated Estradiol.  If you are overweight or a high converter of testosterone to estradiol via aromatase, you can easily get classic high estradiol symptoms:  loss of libido, erecitle dysfunction, gynocomastia, mood swings and prostate issues.  This isn’t the end of the world as an AI (aromatase inhibitor) will usually take care of the problem.  (Generally, Arimidex is employed for this purpose.) However, then you are on a pharmaceutical, which many would consider to be unnatural and risky to their long term health.

6) High Iron.  Good physicians will monitor some combination of your hemoatocrit, hemoglobin and red blood cell counts.  This will allow them to tell if you have too much iron, which in the long term can negatively impact your cardiovascular system and brain.  So, if you come out higher than the range, then you really only have two choices:  1) donate blood regularly or 2) lower your testosterone dosage.  Neither of those may sound fun to you.

7) Cardiovascular Risks.  There is some evidence that the topicals may actually cause cardiovascular issues in some men.  I discuss this in detail in my link on Testosterone Risks. Increasing heart disease is simply NOT something testosterone therapy should do, because low testosterone is a risk factor for hardening of the arteries, metabolic syndrome, diabetes, insulin resistance and a number of other known cardiovascular risk factors.  However, it turns out that the topicals actually increase peripheral estradiol levels and this may be causing issues.

NOTE:  Again, I’ve had a great overall experience with my HRT program, but I still recommend that you also read my link on Testosterone Risks, because it provides some other unusual or controversial aspects of HRT.  Again, well-run HRT clinics are growing and thriving for a reason.  But that does not mean that the ride will always be smooth for all patients.  It is also very important that your doctor know how to screen you before going into testosterone therapy:  men with a past history or existing prostate cancer, kidney issues or hypertension should get expert medical advice before adding testosterone to their regimen.

DOES HRT ALWAYS WORK?It is important to point out that HRT does not always work. Some men are looking for HRT to cure their depression. Testosterone can definitely help, but depression is a complex and multi-faceted condition that usually must be solved through several strategies. HRT does not always cure erectile dysfunction either. An erection is VERY complex and, more often that not, the primary culprit is poor endothelial function, i.e. low nitric oxide levels. So, before you go into HRT, you have to ask yourself the question, “What will I do if I don’t feel anything?” That probably won’t be the case, but you never know.

1)  http://peaktestosterone.com/forum/index.php?topic=1060.0