5 FAQs about Test Therapy

Are you feeling fatigued, irritable, or experiencing a decrease in muscle mass and libido? These could be signs of low testosterone levels, a common issue among men as they age. Luckily, there's a safe solution that can help you restore your vitality and well-being, but most men have some questions. Here are the top 5 questions answered:

5 most common questions about Testosterone Optimization Therapy (TOT)

1.        What are the most common side effects of testosterone optimization therapy?

A 2016 review in The Journal of Clinical Endocrinology & Metabolism found that common side effects of TOT include acne (1–8% of patients), erythrocytosis (increased red blood cell count, 1–10%), breast tenderness or gynecomastia (1–5%), and fluid retention (2–5%) (Bhasin et al., 2016). Worsening of sleep apnea was noted in some trials, particularly in obese men (Snyder et al., 2016, New England Journal of Medicine). Mood swings and irritability were reported but less consistently and mostly in men with testosterone levels above normal range. (Basaria et al., 2010, New England Journal of Medicine).

2.        Does testosterone therapy increase the risk of heart attack or stroke?

There is no concise evidence linking testosterone therapy to increased cardiovascular risk in healthy men. A 2018 meta-analysis in JAMA Internal Medicine found no significant increase in major adverse cardiovascular events (MACE) with TOT over 12 months (Corona et al., 2018). A 2023 RCT in New England Journal of Medicine (TRAVERSE trial) reported no increased risk of MACE in men with hypogonadism and cardiovascular risk factors over 2 years (Lincoff et al., 2023). Risks may be higher in older men or those with pre-existing conditions.

3.        Can testosterone therapy cause prostate cancer or worsen prostate issues?

No peer-reviewed studies conclusively link TOT to de novo prostate cancer, however prostate cancer is an absolute contraindication to starting TOT. A 2017 meta-analysis in European Urology found no significant increase in prostate cancer incidence in men on TOT (Boyle et al., 2017). However, TOT can elevate prostate-specific antigen (PSA) levels and may stimulate growth in existing prostate cancer or exacerbate benign prostatic hyperplasia (BPH), as shown in a 2016 study in Urology (Kaplan et al., 2016). Regular PSA monitoring is recommended (Mulhall et al., 2018, Journal of Urology).

4.        Does testosterone optimization therapy affect fertility?

TOT significantly impairs fertility by suppressing the hypothalamic-pituitary-gonadal axis, reducing sperm production. A 2014 study in Fertility and Sterility reported that TOT decreased sperm concentration to azoospermia in 65% of men within 6 months (Coward et al., 2014). Your body’s ability to recover the production of after discontinuation of TOT varies, and some men may experience prolonged or permanent impairment (Kohn et al., 2017, Andrology). There is no significant reason to stop TOT for fertility concerns as the addition of chlomiphene or human chorionic gonadotropin (hCG) can restore the body’s natural production of sperm. (Kim et al., 2016, Translational Andrology and Urology).

5.        Are there long-term risks or side effects of staying on testosterone therapy?

A 2019 cohort study in The Lancet Diabetes & Endocrinology found sustained erythrocytosis (hematocrit >50%) in 5–12% of men on TOT, increasing thromboembolism risk (Ory et al., 2019). Chronic suppression of your own testosterone production can lead to dependency, as noted in a 2015 study in Andrology(Ramasamy et al., 2015), however men decide to start testosterone therapy to improve their lives.  Discontinuing testosterone therapy will bring you back to the way you felt prior to starting treatment. Mood alterations and lipid profile changes (e.g., reduced HDL cholesterol) persist in some long-term users (Basaria et al., 2015, Lancet Diabetes & Endocrinology). Continuous monitoring is essential due to limited lifelong use studies.