Since the ancient alchemists of Egypt, mankind has been looking for the “fountain of youth.” A substance, supplement or incantation that will keep us in the prime of life for… well, forever. Modern man is no less obsessed with pursuing never-ending vitality. Over the past several years a new candidate has emerged for the title of verified “fountain of youth.” It is abbreviated “TRT” but stands for Testosterone Replacement Therapy.
Testosterone: what does it do?
Among many other functions, the hormone testosterone performs the following:
1. increases bone density
2. increases energy levels
3. increases muscle mass
4. increases production of red blood cells
5. increases mental acuity
6. increases aggression
As men hit their fifth decade of life (40-49 years of age) they lose about 1% of their overall testosterone production per year. Not surprisingly, it is common for 40-year old men to seek testosterone replacement therapy in order to compensate for lowered sexual, work and/or sports performance.
Testosterone Replacement Therapy (TRT)
TRT is usually administered at 125 mg per week. This is considered the “physiological dose” as it mimicks the average production of testosterone in the average male. At first, this dosage is assisted by the man’s already naturally produced testosterone. So the early usage of TRT will be felt more acutely. As time goes on, however, the male testes produce less and less due to the incoming testosterone from the therapy. This is one of the down sides to TRT: your body loses its ability to produce its normal, maximum amount of testosterone and you are forced to take TRT long-term to keep from experiencing unusually low testosterone levels.
Before going on TRT you should have your testosterone levels checked. Some people warn that you should make sure the lab you use knows the difference between free-testosterone and total body testosterone. Free-testosterone is the only testosterone you have in your body that you can actually access, the rest being bound up and non-available. Personally, I don’t think this is necessary as I don’t know of any condition that would give you a high total body testosterone count but a low free-testosterone count. They come in combination. If one is high, so is the other. If one is low, so is the other. A normal total body testosterone count for males ranges from 225 to 1,110 nanograms of testosterone per deciliter of blood (ng/dl). The average being about 650 ng/dl. So if you are below the 225 ng/dl limit, you may want to talk to your doctor about TRT. However, if you are a man and have a “low” testosterone count but are not experiencing any of the following symptoms:
- chronic lethargy
- inability to get or maintain an erection
- low sex drive
- breast tissue growth (gynecomastia)
…then you may be fine with the levels of testosterone in your body. This may be natural for your genetics. If you have both a low count (below the normal range) and have the above symptoms, TRT may be right for you.
Are There Any Risks with TRT?
However, they are not well known or well established. Because testosterone increases red blood cell production it has been found to increase stroke and heart attack risks. The reason for this is simple. When your hematocrit count increases (number of red blood cells per given volume of blood plasma) the thickness and “stickiness” of your blood also increases. With chronic synthetic testosterone levels comes chronic increases in blood thickness and “stickiness” which makes the heart work harder to pump blood and puts more pressure on vessel walls. It also increases the chance of blood clot formation. A November 2013 article in the Journal of the American Heart Association stated that testosterone replacement drugs increased chances of heart attack in men by 30%. And a January 2014 article by the UCLA research department (in conjuction with the National Institute of Health) made the dramatic statement that shortly after use, men under 65 who were on TRT had twice the chances of heart attacks. More time will have to pass before we know the full correlation between TRT usage and heart health, but we do have some red flags thus far. TRT drugs have now surpassed Viagra in total yearly sales in the U.S. (according to drugs.com). Millions of men take TRT-type drugs every year in the U.S. so we are bound to start picking up trends as time goes by.
Many urologists warn of the possible increase in prostate cancer risks for men using TRT. This has not been as well established as the above mentioned heart health issues. Actually, it is mainly based on theory. For years, oncologists and urologists have seen that men with low testosterone have better chances of recovering from prostate cancer. This has led to the long held belief that high testosterone equals higher chance of developing prostate cancer. However, this link is, so far, only theoretical.
What is my advice?
I do not give medical advice as I am not a medical doctor. What I tell you is only my professional opinion and I stress that you should make this decision with your medical doctor as well as your own thorough research. You are making long term health decisions and so you should be involved in the data gathering process.
However, my advice is to stay away from TRT if you are not genuinely suffering from hypogonadism. This accounts for most people. Having a lower testosterone count can be like having a high or low score on the Body Mass Index (BMI). In short, it does not mean much. I am of average height for a male but I am muscular for my age, so I score as “moderately obese” on the BMI. But anyone who looks at me will know that I am perfectly healthy. And my blood work and endurance would prove it as well. Therefore, if you feel good and do not have any symptoms of hypogonadism I would not be bothered by your total testosterone count unless it is much lower than the 225 ng/dl bottom limit.
Most TRT users are males in their 30’s and 40’s who want to perform athletically and sexually at their peak levels. They are young enough to remember what they used to feel like energy-wise and how they used to be able to train harder and recover more quickly. In short, it appears most TRT users are not truly hypogonadic. I can understand the attraction of having a veritable “fountain of youth” at your disposal, but I also know that there is no truly natural way to cheat Father Time.
Be aware of the risks, be informed and then be at peace with your decision.