by: Jordan Palmer and Kimberly Fitterer

Testosterone replacement therapy (TRT) is a treatment designed to boost testosterone levels in individuals who have low testosterone due to various medical conditions. While the therapy can offer benefits like improved mood, increased muscle mass, and enhanced sexual function, it poses several risks and potential dangers.

Should you have any questions about this article, don’t hesitate to contact Advanced Practice Registered Nurse Kimberly Fitterer by emailing us using the email address for members. 

Why testosterone replacement therapy (TRT) can be dangerous for men:

TRT can increase the risk of cardiovascular issues. Some studies have linked testosterone therapy to a heightened risk of heart attacks, strokes, and other cardiovascular events, especially in older men or those with pre-existing heart conditions. This suggests that the therapy may contribute to the formation of blood clots or exacerbate underlying heart disease. Testosterone Replacement Therapy can be associated with polycythemia, a blood cancer with an increase in red blood cell count, leading to thicker blood.

Testosterone replacement in men can negatively impact the prostate. Increased testosterone levels may stimulate prostate tissue growth, potentially leading to benign prostatic hyperplasia (BPH) or even prostate cancer. This aspect is of particular concern for men with a history of prostate issues (or a family history of any cancer), as the therapy could accelerate the progression of these conditions.

Additionally, TRT can affect fertility. Administering external testosterone can suppress the body’s natural hormone production, particularly impacting the hypothalamic-pituitary-gonadal axis. This suppression can lead to reduced sperm production and even infertility, posing a significant concern for men who wish to father children.

Another potential danger of testosterone replacement is the risk of exacerbating sleep apnea. Sleep apnea is a condition characterized by interrupted breathing during sleep, which can worsen with TRT due to the hormone’s effect on respiratory muscles and breathing control.

Moreover, TRT may lead to mood swings and other psychological effects. While it can initially improve mood, some individuals may experience increased irritability, aggression, or other mood disorders as a side effect of altered hormone levels.

Conclusion

While testosterone replacement therapy might provide relief and benefits for those with low testosterone levels, it is not without its risks. Careful medical evaluation and monitoring are crucial to mitigate risks and ensure safe treatment. Testosterone Replacement Therapy should only be administered under an endocrinologist’s careful and watchful eye.

Sources:
– Basaria, S. (2010). Testosterone therapy in older men with low testosterone levels. Journal of Clinical Endocrinology & Metabolism, 95(6), 2656-2668.
– Morgentaler, A., & Traish, A. M. (2009). Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. European Urology, 55(2), 310-321.
– Traish, A. M., Haider, A., Doros, G., & Saad, F. (2011). Long-term testosterone therapy in hypogonadal men ameliorates elements of the metabolic syndrome: an observational, long-term registry study. International Journal of Clinical Practice, 65(6), 683-691.
– Baillargeon, J., Urban, R. J., Ottenbacher, K. J., Pierson, K. S., Lethbridge-Çejku, M., & Goodwin, J. S. (2010). Trends in androgen prescribing in older men with prostate cancer. Journal of Urology, 183(4), 1314-1319.
– Wang, C., Jackson, G., Jones, T. H., Matsumoto, A. M., Nehra, A., Perelman, M. A., & Zitzmann, M. (2011). Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care, 34(7), 1669-1675.

 

Why testosterone replacement therapy (TRT) can be dangerous for women:

Testosterone replacement therapy (TRT) in women poses several potential risks and dangers, primarily because testosterone is not the primary hormone for female bodies. Administering testosterone can lead to a hormonal imbalance, causing various physiological and psychological effects.

First, excessive testosterone in women can result in virilization, which refers to the development of male characteristics. This can include increased body hair, deepening of the voice, and changes in body fat distribution. These changes can be distressing and often have a lasting impact even if the therapy is discontinued.

Moreover, high levels of testosterone can contribute to cardiovascular problems. Women on testosterone replacement may experience elevated cholesterol levels and increased risk of hypertension, potentially escalating the risk for heart disease. Additionally, there’s a risk that testosterone could negatively impact liver function, as it is metabolized in the liver, and excessive amounts could lead to liver toxicity over time.

Psychologically, women on TRT may experience mood swings, aggression, or other mental health challenges due to the imbalance of hormones. Clinically, women naturally produce testosterone in smaller amounts, so introducing external sources can disrupt the delicate hormonal balance and lead to psychological distress or behavioral changes.

Another important concern is the lack of extensive research on long-term effects of testosterone therapy in women. Most studies have been conducted in males, leaving a gap in understanding its safety and efficacy for females. Without comprehensive studies, predicting the full spectrum of potential side effects and long-term outcomes of TRT in women becomes challenging.

While testosterone replacement therapy (TRT) can help you get through menopause, it may come with risks.

Possible health risks include:

• Increased risk of uterine cancer (only if you still have your uterus and aren’t taking progestin along with estrogen).
• Increased risk of heart disease if you begin using HRT 10 years after menopause starts.
• Increased risk of blood clots and stroke.
• Increased risk of gallbladder disease.
• Increased risk of breast cancer with long-term use in some people.

Many of these possible risks also have to do with your overall health and family history of health conditions.

Conclusion

In summary, while testosterone replacement therapy may offer benefits in specific clinical situations, it also carries significant risks for women due to hormonal imbalances and potential physical and psychological consequences. Careful medical evaluation and monitoring are crucial to mitigate risks and ensure safe treatment. Testosterone Replacement Therapy should only be administered under an endocrinologist’s careful and watchful eye; women should also include their gynecologist in any hormone replacement therapy.

Sources:
1. Davison, S. L., Bell, R., Donath, S., & Davis, S. R. (2005). Androgen levels in adult females: changes with age, menopause, and oophorectomy. The Journal of Clinical Endocrinology & Metabolism, 90(7), 3847-3853.
2. Traish, A. M., Guay, A. T., Feeley, R. J., & Saad, F. (2009). The dark side of testosterone deficiency: III. Cardiovascular disease. Journal of Andrology, 30(5), 477-494.
3. Gleicher, N., Weghofer, A., & Barad, D. H. (2007). Too much testosterone? Archives of Gynecology and Obstetrics, 276, 245-250.
4. Finkelstein, J. S., Lee, H., Burnett-Bowie, S. A., Pallais, J. C., Yu, E. W., Borges, L. F., … & Leder, B. Z. (2013). Gonadal steroids and body composition, strength, and sexual function in men. New England Journal of Medicine, 369(11), 1011-1022.
5. Basaria, S. (2010). Androgen abuse in athletes: detection and consequences. The Journal of Clinical Endocrinology & Metabolism, 95(4), 1533-1543.

Why testosterone replacement therapy (TRT) can be dangerous for women:

Testosterone replacement therapy (TRT) in women poses several potential risks and dangers, primarily because testosterone is not the primary hormone for female bodies. Administering testosterone can lead to a hormonal imbalance, causing various physiological and psychological effects.

First, excessive testosterone in women can result in virilization, which refers to the development of male characteristics. This can include increased body hair, deepening of the voice, and changes in body fat distribution. These changes can be distressing and often have a lasting impact even if the therapy is discontinued.

Moreover, high levels of testosterone can contribute to cardiovascular problems. Women on testosterone replacement may experience elevated cholesterol levels and increased risk of hypertension, potentially escalating the risk for heart disease. Additionally, there’s a risk that testosterone could negatively impact liver function, as it is metabolized in the liver, and excessive amounts could lead to liver toxicity over time.

Psychologically, women on TRT may experience mood swings, aggression, or other mental health challenges due to the imbalance of hormones. Clinically, women naturally produce testosterone in smaller amounts, so introducing external sources can disrupt the delicate hormonal balance and lead to psychological distress or behavioral changes.

Another important concern is the lack of extensive research on long-term effects of testosterone therapy in women. Most studies have been conducted in males, leaving a gap in understanding its safety and efficacy for females. Without comprehensive studies, predicting the full spectrum of potential side effects and long-term outcomes of TRT in women becomes challenging.

While testosterone replacement therapy (TRT) can help you get through menopause, it may come with risks.

Possible health risks include:

• Increased risk of uterine cancer (only if you still have your uterus and aren’t taking progestin along with estrogen).
• Increased risk of heart disease if you begin using HRT 10 years after menopause starts.
• Increased risk of blood clots and stroke.
• Increased risk of gallbladder disease.
• Increased risk of breast cancer with long-term use in some people.

Many of these possible risks also have to do with your overall health and family history of health conditions.

Conclusion

In summary, while testosterone replacement therapy may offer benefits in specific clinical situations, it also carries significant risks for women due to hormonal imbalances and potential physical and psychological consequences. Careful medical evaluation and monitoring are crucial to mitigate risks and ensure safe treatment. Testosterone Replacement Therapy should only be administered under an endocrinologist’s careful and watchful eye; women should also include their gynecologist in any hormone replacement therapy.

Sources:
1. Davison, S. L., Bell, R., Donath, S., & Davis, S. R. (2005). Androgen levels in adult females: changes with age, menopause, and oophorectomy. The Journal of Clinical Endocrinology & Metabolism, 90(7), 3847-3853.
2. Traish, A. M., Guay, A. T., Feeley, R. J., & Saad, F. (2009). The dark side of testosterone deficiency: III. Cardiovascular disease. Journal of Andrology, 30(5), 477-494.
3. Gleicher, N., Weghofer, A., & Barad, D. H. (2007). Too much testosterone? Archives of Gynecology and Obstetrics, 276, 245-250.
4. Finkelstein, J. S., Lee, H., Burnett-Bowie, S. A., Pallais, J. C., Yu, E. W., Borges, L. F., … & Leder, B. Z. (2013). Gonadal steroids and body composition, strength, and sexual function in men. New England Journal of Medicine, 369(11), 1011-1022.
5. Basaria, S. (2010). Androgen abuse in athletes: detection and consequences. The Journal of Clinical Endocrinology & Metabolism, 95(4), 1533-1543.