Low testosteronecan be the culprit behind a number of health problems, and for some men,testosterone replacement therapy(TRT) is the answer. But the treatment itself may cause other health problems, too.
Apoor sex drive, weaker and fewer erections, weight gain, lethargy, and depression all can stem from abnormallylow testosterone levels. About four in 10 men over the age of 45, two in 10 over age 60, and three in 10 over age 70 may have low testosterone, according to the American Urological Association (AUA).
If low testosterone is found to be the only cause of your symptoms, your doctor may prescribe TRT, which comes in a variety of forms, including skin gel, patches, or shots. TRT can help bring your testosterone levels into a normal range and relieve your symptoms. But before you start TRT, you and your doctor should discuss possible side effects.
“As with any medication, it’s always a balance — are you getting benefits from the treatment versus side effects?” says Suzanne Kavic, MD, a reproductive endocrinologist at Loyola Medicine in Chicago.
Possible Side Effects of Testosterone Replacement Therapy
TRT can cause acne, breast tenderness, and low sperm count, saysJay Simhan, MD, a urologist at the Einstein Healthcare Network in Philadelphia. It also can cause some potentially serious side effects, including:
A high red blood cell count.“This can be quite serious because as the number of red blood cells increase, your blood becomes thicker and therefore more likely to clot,” saysHarris Nagler, MD, chair emeritus of the Sol and Margaret Berger Department of Urology and professor of urology at the Icahn School of Medicine at Mount Sinai in New York City. “There’s a risk ofthrombosisand blood clots that could affect the heart, lungs, or brain,” he says. Talk with your doctor about how frequently you needblood teststo check your red blood cell level.
Fluid retention in your feet or ankles.This is especially a problem for men with high blood pressure orcongestive heart failurebecause swelling can make these conditions worse, Dr. Simhan says. Swelling in your legs and ankles could also indicate a blood clot. Alert your doctor if you notice swelling.
Sleep apnea.Taking testosterone may cause or worsensleep apnea, a condition in which you frequently stop breathing for short periods during sleep, Simhan says. Sleep apnea can lead to high blood pressure and cardiovascular disease, according to the American Sleep Apnea Association. Also, if your sleep is constantly interrupted, you can be overly tired at work or when driving, increasing your risk for an accident.
Cardiovascular disease.The link between TRT and heart disease is still being studied. A study published in November 2013 in theJournal of American Medical Associationinvolving veterans found that those taking TRT increased their chances of having a heart attack or stroke.
However, the veterans in the study had a history of heart disease, and it's not clear whether the results would apply to healthier men. That’s why “concerns have been expressed about this study,” Nagler says. “Nevertheless, until it’s proven not to be the case, it’s something to consider when deciding to prescribe testosterone.”
It’s important to be aware of the signs andsymptoms of a heart attackor stroke and get medical help immediately if you experience any of them. These include:
- Chest pain
- Difficulty breathing orshortness of breath
- Feeling weak in a part or side of the body
- Slurring your speech
Prostate growth.TRT also can stimulateprostatecells to grow. If you already have anenlarged prostateor blood in your urine, taking testosterone could make these problems worse. An enlarged prostate can lead tofrequent urination, so talk with your doctor if you find you are going more frequently.
There’s no evidence that TRT can increase a man’s chances of developingprostate cancer, but more research is needed in this area, according to the AUA.
为了安全起见,如果你服用睾酮,讨论with your doctor about how frequently you should have prostate exams and have your blood tested for prostate-specific antigen (PSA) to check for prostate cancer, Nagler says.
Risks Versus Benefits of Testosterone Replacement Therapy
Hormones tend to work if you take them correctly, Dr. Kavic says. ButTRTdoesn’t work for everyone. Some men will see a benefit and have few or manageable side effects, while others may see little benefit or experience more serious side effects.
It's important to work with your doctor to monitor for side effects and test your testosterone level to be sure you’re getting the benefit of treatment, Kavic says. During the first year of treatment, most men should see their doctor every three months to have their blood and testosterone levels checked. If you’re healthy, follow-up visits may be spaced out to every six months after the first year.
