Introduction
Testosterone therapy (TT) is commonly used to treat men with low testosterone levels, a condition known as hypogonadism. The therapy aims to restore normal testosterone levels and alleviate symptoms such as reduced libido, muscle mass, and mood disturbances. However, the risks and benefits of testosterone therapy remain a topic of ongoing debate and research.
Key Insights
Benefits of Testosterone Therapy
- Improvement in Sexual Function and Libido: Testosterone therapy has been shown to improve libido and sexual function in men with hypogonadism .
- Increased Muscle Mass and Strength: TT is associated with increased lean body mass and muscle strength, as well as reduced fat mass and waist circumference .
- Enhanced Mood and Cognitive Function: Several studies report improvements in mood, cognitive function, and overall quality of life with testosterone therapy .
- Cardiovascular Benefits: Some studies suggest that normal testosterone levels are inversely associated with cardiovascular risks and mortality, and TT may improve cardiovascular health, especially in men with metabolic diseases .
- Bone Density and Erythropoiesis: TT can improve bone density and stimulate erythropoiesis, which is beneficial for men with low red blood cell counts .
Risks of Testosterone Therapy
- Cardiovascular Risks: While some studies suggest potential cardiovascular risks, such as increased risk of heart attack and stroke, these findings are often based on studies with methodological flaws. The majority of evidence does not support a significant increase in cardiovascular risks with TT .
- Prostate Health: There is no consistent evidence that TT increases the risk of prostate cancer or worsens benign prostatic hyperplasia, although caution is advised in men with a history of prostate cancer .
- Erythrocytosis: TT is associated with an increase in hemoglobin and hematocrit levels, which can lead to erythrocytosis, particularly with intramuscular formulations .
- Lipid Profile Changes: TT can lead to a decrease in high-density lipoprotein (HDL) cholesterol and an increase in low-density lipoprotein (LDL) cholesterol, although the clinical significance of these changes is uncertain .
- Other Risks: Potential risks include liver toxicity, worsening of untreated sleep apnea, and severe heart failure. Acne and alopecia are also reported side effects .
Conclusion
Testosterone therapy offers several benefits, including improved sexual function, increased muscle mass, enhanced mood, and potential cardiovascular benefits. However, it also carries risks such as erythrocytosis, changes in lipid profiles, and potential cardiovascular concerns. The decision to initiate TT should involve a thorough discussion between the patient and physician, weighing the potential benefits against the risks. Further long-term, large-scale studies are needed to better understand the safety and efficacy of testosterone therapy.