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Dr. Brynna Connor, MD
Dr. Brynna Connor
Healthcare Ambassador at NorthWestPharmacy.com

Hormones

Hormonal Replacement Therapy for Men

December 17, 2020

Testosterone is a natural hormone that is necessary to keep many different parts of the body working properly. It is particularly important in men, where it controls reproductive health. When the body doesn't make enough testosterone, men can take extra laboratory-made testosterone as a medication in order to keep the body healthy.

Hormones in Men

Hormones are chemical signals that the body uses to coordinate many different processes. Small structures called glands make hormones and send them throughout the body, where they communicate messages to other tissues and organs.

Some hormones have the same function in each person. For example, the pancreas produces the hormone insulin, which controls levels of sugar in the blood. However, some hormones have more specific functions in males and females. The reproductive hormones or sex hormones are responsible for the changes that happen to the body during puberty. In males, these include the growth of facial and body hair, the deepening of the voice, and the growth of new muscle and bone. All of these processes are controlled by testosterone, which is made by the testes. This hormone also maintains fertility by helping make sperm and plays a role in sexual health by controlling sex drive and erections. It is also involved in non-sexual functions, such as creating new red blood cells. Both males and females have testosterone in their bodies, but males typically have much higher levels.

Testosterone Replacement Therapy

During testosterone replacement therapy, or TRT, people take testosterone in the form of a pill, cream, gel, drops, or injection. There are a couple of reasons why a man may consider using TRT.

Hypogonadism

In some cases, a person's body doesn't make enough reproductive hormones, or it stops producing them altogether. There are a few different things that may cause this:

  • Genetic disorders
  • Infection
  • Autoimmune disorders
  • Radiation
  • Certain types of surgery
  • Trauma to the testes
  • Damage or changes to certain regions of the brain

Someone may be born with hypogonadism, or they may develop it later in life. The treatment for this condition is to give the body extra testosterone in order to bring levels closer to normal.

Older Age

Our hormone levels change as we age. This phenomenon is much more obvious in females, as many seem to experience a more drastic drop in hormones than men. The female body stops producing the reproductive hormones estrogen and progesterone when females are in their 40's or 50's in a process known as peri-menopause and menopause.

For males, hormone changes are much more subtle. Starting around the age of 30 or 40, testosterone levels slowly decrease as a male ages, at a rate of about 2% per year. This is a natural, normal process, and it's not necessary for males to boost their testosterone levels unless there's an underlying health problem that causes hypogonadism. However, some men feel that taking testosterone can give them other positive benefits, although TRT comes with risks too.

The FDA has approved the use of certain testosterone products for men who have a diagnosed medical condition that demonstrates a low testosterone level. The FDA advises that men without these conditions should not use testosterone, even if their natural testosterone levels have started to drop with age. This is a result of their studies to date, although there is much more being studied in the field of anti-aging and regenerative medicine and many new studies in this area ongoing.

How Do I Know If My Testosterone Levels are Low?

Low testosterone levels may not cause symptoms for some people, but in others they may lead to:

  • Low sperm count, because testosterone is needed to make sperm cells
  • Reduced sex drive
  • Problems with having an erection
  • Difficulty sleeping
  • Thinner bones
  • More fat
  • Mood problems such as depression
  • Trouble concentrating or focusing

If you think you are experiencing symptoms of low testosterone, talk to your healthcare provider. They may give you a testosterone levels test in order to check how much of the hormone your body is making. For this test, a healthcare professional will draw some blood from your arm, and then measure the amount of testosterone in your blood. If your testosterone levels are unusually high or low, this may be a sign of an underlying disease or medical condition.

TRT May Help Men With Low Testosterone Levels

In the past several years, researchers conducted as series of seven different trials that studied the effect of TRT on different aspects of men's health. Each trial included older men who had low testosterone levels and related symptoms, and gave them TRT for one year. The trials discovered:

  • Physical function: Men who took TRT could walk further, meaning that they had better endurance and physical fitness levels.
  • Sexual function: TRT boosted many aspects of sexual function, including sex drive and ability to have an erection.
  • Vitality: TRT increased energy, but only by a small amount. It also led to a small increase in mood and helped men feel a little less depressed.
  • Cognitive function: TRT did not improve memory or brain function.
  • Anemia: Testosterone helps the body make new red blood cells. Men who had anemia (low red blood cell counts) were able to treat it by taking TRT.
  • Bone health: Men on TRT had more bone density and bone strength.
  • Heart health: TRT led to increased levels of plaque in the arteries. This is a major concern, because when plaque builds up, it can lead to a heart attack or heart failure.

Other clinical trials have also shown that TRT can have certain benefits. Testosterone plays a role in building and maintaining muscle mass and strength. This may be especially important as a person ages, since people tend to lose muscle mass the older they get. Many other studies have also shown that TRT can improve sex drive and sexual function, but only for men who previously had very low testosterone levels.

All of these studies only included men with low testosterone levels. Very little research has been done on men with normal hormone levels, however. While some men say they feel more energetic while taking testosterone, there's not much scientific evidence that says that most men will get much benefit with this treatment. TRT is a useful therapy only for men with low testosterone levels.

Risks of HRT

TRT comes with several risks, some of which may be fairly serious. Like any medication, taking testosterone has possible side effects. These include:

  • Enlargement of the breasts
  • Shrinking of the testicles
  • Lower levels of HDL (good) cholesterol
  • Increased numbers of red blood cells, which can make the blood stickier and may raise a person's chance of getting a blood clot
  • Sleep apnea, a sleep disorder which can sometimes be serious
  • An enlarged prostate
  • Infertility, which means that men who are trying to have children should not take TRT

TRT can also raise a person's chance of having a heart attack or stroke, both of which can be fatal. In fact, one clinical trial had to be stopped early because there were so many issues. The trial included men who were over the age of 65 and had mobility issues. The participants used a testosterone gel every day. Researchers stopped the study early after many men experienced heart problems including chest pain, fainting, abnormal heart rhythms, and heart attacks.

People who use TRT also need to make sure they don't expose others to their medication. Some of these products are topical, meaning you rub them onto your skin rather than putting them directly in your body by swallowing or injecting them. Testosterone gels or creams may sit on the skin's surface for a little while before being absorbed, which means that other people that touch the skin may also end up absorbing testosterone. The FDA put a warning on these products after several children became sick when were in contact with people who used these gels. If you use testosterone products that go on your skin, make sure to cover your skin after applying so your children won't come into contact with it.

The FDA has only officially approved TRT for men who have medical conditions that lower their levels of testosterone. The FDA has released a warning that for healthy men, the risks might not be worth the benefit. A few medical groups, including the American Urological Association, European Association of Urology, and the Endocrine Society, suggest that only men with low testosterone levels should use TRT. Experts say that men who do not have hypogonadism should not use TRT. As previously mentioned, however, the data we have now does demonstrate the need to stay informed of all current data and studies since this is a rapidly progressing field of medicine.

Raising Your Testosterone Naturally

While some scientific research has found that testosterone levels often decline with age, other studies have found that this may not hold true for men who are in very good health. This has led some scientists to speculate that aging may not directly make testosterone levels drop. Instead, decreased hormone levels may be due to health problems that become more common as we age.

Keeping yourself healthy may keep your testosterone levels at normal levels, or may raise them after they've become low. Some things that may help boost your body's own natural production of testosterone include:

  • Move more throughout the day: Men who are more physically active tend to have higher testosterone levels. For males who are more sedentary, changing habits now can make a difference. In one study, researchers asked overweight or obese men to start getting more steps in throughout the day. The more steps men took, the more their testosterone levels rose.
  • Hit the gym: Researchers have long known that resistance training such as weight lifting can raise testosterone levels. Other types of workouts may help, too. High-intensity interval training (HIIT), which consists of short bursts of high-effort aerobic exercise, can lead to more testosterone in the blood. Additionally, men who have higher levels of cardiorespiratory fitness have higher testosterone. Cardiorespiratory fitness is a measure of how well your heart and lungs can deliver oxygen to your muscles. You can increase it through aerobic exercise, so things like running, swimming, or dancing may help support healthy testosterone levels.
  • Stay at a healthy weight: Men with more belly fat often have lower levels of testosterone and higher levels of estrogen. Losing extra fat helps prevent your testosterone levels from dropping as you age.
  • Get more vitamin D: In one clinical trial, men who took vitamin D supplements every day for one year raised their testosterone levels. You can buy vitamin D supplements over-the-counter, or get more of this vitamin by getting more sunlight. It's also found in fatty fish like salmon and sardines, eggs, mushrooms, canned tuna, and milk.
  • Take a ginger supplement: Ginger boosted testosterone levels by 17.7% in one study. It also enhanced sperm health.
  • Develop other healthy living habits: Getting more sleep, quitting smoking, limiting alcohol, and reducing stress have all been linked to higher testosterone levels.

Many of these strategies also improve health in other ways, too. Incorporating some of these testosterone boosters into your life may help support healthy aging throughout your body.

Conclusion

It's normal for testosterone levels to drop as you get older. The decision to treat this situation is very personal and is worthy of a conversation between patient and physician, In men with hypogonadism, TRT can reduce or eliminate symptoms and help them function normally. For men who are fairly healthy, TRT may provide health benefits and the risks and benefits of such therapy must be discussed with one's physician as every single patient is unique in terms of family history and personal goals. In addition, men can also work to boost testosterone levels naturally through diet, exercise, and supplements.

Please consult with your physician about the benefit of this type of hormone therapy and how it might work for you!

Articles authored by Dr. Connor are intended to facilitate awareness about health and wellness matters generally and are not a substitute for professional medical attention or advice from your own healthcare practitioner, which is dependent on your detailed personal medical condition and history. You should always speak with your own qualified healthcare practitioner about any information in any articles you may read here before choosing to act or not act upon such information.