A Conversation with Dr. Burnett
On January 31, 2014, the Food and Drug Administration (FDA) stated they would study the risk of heart attack, stroke and death in men taking testosterone replacement therapy (TRT). This was after two recent studies suggested that TRT raises the risk of heart attack in men.
The American Urological Association (AUA) has followed these reports closely. The AUA notes there are also conflicting studies suggesting TRT may lower heart attack risk. More studies need to be done to be certain whether and how TRT changes men’s risk of heart attack.
The AUA is also concerned about misuse of TRT. You should not take testosterone for non-medical reasons, such as bodybuilding, preventing aging changes or performance enhancement. Men should not take TRT if they have normal testosterone levels or if their testosterone levels have not been tested. If you have normal testosterone levels, using TRT will not help your health problems.
Q: I’ve heard about men taking testosterone replacement therapy for “low-T.” What is low-T, and how do I find out if I have it?
A: Low-T is also known as hypogonadism, which happens when a man does not have enough testosterone in his body. Testosterone is the sex hormone that helps boys grow into men. This hormone is key during puberty and in the development of male physical features. Testosterone levels can affect men’s sex drive, erections, mood, muscle mass and bone density. Testosterone is also needed for normal sperm production.
You may have low-T if you have the following problems:
- reduced sex drive
- less frequent sexual activities
- fewer and weaker erections
- less energy
- depressed mood
- less muscle mass and strength
- more body fat
- anemia (low iron)
- loss of bone strength
If you think you may have low-T, it is important to see a doctor, who will examine you and evaluate your health history. A blood test can measure your testosterone levels.
Q: How do I know if testosterone replacement therapy (TRT) is right for me?
A: If you are having one or more of the symptoms of low-T, it is important to make sure you have low-T and not another condition. Many of the symptoms for low-T can be the result of other health problems. For example, erectile dysfunction (ED) may be caused by poor cardiovascular health instead of low-T. TRT can help men with low-T, but you should not be taking TRT if you do not have low levels of testosterone.
Before you take TRT, a doctor who is skilled in diagnosing low-T should examine you carefully. Your doctor should not prescribe TRT without taking an in-depth health history, giving you a physical exam and performing blood tests. Your doctor should talk to you about the possible benefits, side effects and risks before you start taking TRT. You and your doctor can then decide whether TRT is right for you.
Q: What are other possible side effects and risks from TRT?
A: The following are possible side effects and risks that may be caused by TRT:
- acne (pimples)
- breast swelling or soreness
- a high red blood cell count
- swelling of the feet or ankles
- smaller testicles
Men interested in fertility should know that taking TRT can lower sperm production. Men with advanced prostate cancer should avoid taking TRT because it may help prostate cancer grow.
Q: What else should I know about TRT?
A: It is important to talk with your doctor about the benefits and risks of taking testosterone replacement therapy. You should know that today’s science does not offer final answers about whether taking TRT will increase your risk of prostate cancer or heart disease. If you and your doctor decide TRT is right for you, you should have regular check-ups. Your doctor should follow up with blood tests for testosterone level, PSA and hematocrit. PSA is a test for prostate issues, including prostate cancer, and hematocrit measures how many red blood cells you have. Based on your health history, your doctor may want to follow up with other tests.
It is important to talk with your doctor about the benefits and risks of taking testosterone replacement therapy. You should know that today’s science does not offer final answers about whether taking TRT will increase your risk of prostate cancer or heart disease. If you and your doctor decide TRT is right for you, you should have regular check-ups.
Dr. Arthur L. Burnett, MD, MBA, FACS, is the Patrick C. Walsh Distinguished Professor of Urology and Director of the Sexual Medicine Fellowship Program at Johns Hopkins Medical Institutions. Dr. Burnett answers patients’ questions on testosterone replacement therapy.