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July 20, 2012

The Side Effects of Testosterone Replacement

The Side Effects of Testosterone Replacement

Side Effects of Testosterone Replacement Therapy

Have you seen the “Low T” commercials?  And have you  seen the commercials and ads showing the 70-year-old well-sculpted doctor discuss the Cenegenics’ Age Management Program? What about steroids in sports? Have you heard all the dangers associated with anabolic steroid use in athletes?

If so, you’re probably a bit confused to say the least. Can testosterone, a substance the body naturally make, be so beneficial to our health, yet so dangerous? In a nutshell, only if it is misused in high doses. But, there are risks even at therapeutics doses that all should know.

Testosterone in Perspective

Testosterone is a hormone made by men, women, and children. The body has receptors for testosterone throughout the body, just like it does for all hormones. So while we think of testosterone as a sex and muscle hormone, it is in fact, a total body hormone.

As we age testosterone levels decline in both men and women. At some point levels drop below a critical threshold unique to each individual leading to a variety of signs and symptoms.

Athletes versus Patients

There’s a big difference between athletes taking high doses of testosterone and other anabolic steroids to enhance athletic performance and the restoring of testosterone levels to a healthy normal range that we do in patients low in testosterone. Any drug/hormone taken in doses far beyond what the body needs is going to cause problems.

Testosterone versus Synthetic Anabolic Steroids

Anabolic steroids are synthetic versions of testosterone designed to promote more muscle building effects than the testosterone the body makes. Thus, they are more potent than testosterone leading to more side effects.

In addition, they are not structurally the same as testosterone which can lead to problems when the body metabolizes anabolic steroids. The metabolites can have side effects as well.

Safety of Testosterone

Testosterone is safe when used to restore testosterone levels to a normal healthy range in men and women who are testosterone deficient. But, its use must be closely monitored by a physician familiar with the potential side effects.

All drugs have side effects and there are potential risks in taking any drug.  Testosterone is no different.  In my opinion though, it is safer than many drugs commonly used to treat cholesterol, diabetes, and high blood pressure, while having much more overall health benefit.

Side Effects of Testosterone

The side effects of testosterone are well-known and can be anticipated.  Many of these side effects can either be managed by simply reducing the dose, or can be off-set by use of other drugs if necessary.

First, there can be allergic reactions to all drugs.  When it comes to testosterone this would be related to an inactive ingredient in the preparation, or in the case of injectable testosterone the oil suspension (sesame or cottonseed).

Some side effects are related to route of administration.  Gels or creams can cause skin irritation or rashes.  Injections can cause infection if proper technique is not used.

Other side effects of testosterone therapy include:

  • Acne or oily skin
  • Excessive hair growth
  • Testicular atrophy or shrinkage
  • Breast enlargement or gynecomastia (from elevated estradiol levels)
  • Hair growth in women
  • Mild fluid retention
  • Exacerbation of sleep apnea (rare and I have not seen this)
  • Increased red blood cell count (erythrocytosis)
  • Prostate enlargement
  • Decreased sperm count

Breast enlargement is the result of conversion of testosterone to estradiol (the “female” hormone).  This can be minimized by lowering the dose, or in the case of testosterone injections reducing the dose and doing injections more frequently. Zinc can block the conversion of testosterone into estradiol as can chrysin which can be obtained over the counter.  If necessary aromatase inhibitors can be prescribed which are very effective in lowering estradiol levels.

The rise in red blood cell count (hemoglobin and hematocrit) is more common with testosterone injections and also can be minimized by reducing the dose or performing more frequent injections at a smaller dose. Periodic donation of blood is another to way to manage an elevate red blood cell count.

Prostate enlargement is the result of conversion of testosterone to dihydrotestosterone (DHT).  Conversion to DHT is more likely with topical testosterone as the enzyme responsible for this conversion exists in high concentrations in the skin.

Excessive DHT can lead to male-pattern baldness. Drugs called 5 alpha-reductase inhibitors can block the conversion of testosterone to DHT.  Switching from a topical testosterone to an injectable form can also be considered.

Since testosterone is being provided to the body in replacement therapy the testes no longer have to make it themselves and they can shrink in size. For similar reasons, sperm counts can decrease. but frequently will return to baseline levels after stopping testosterone replacement. Though it can take several months for sperm counts to bounce back. Administration of HCG can prevent/minimize testicular atrophy and preserve sperm counts.

As you can see there are some side effects and risks associated with testosterone, and from a physician’s perspective testosterone replacement is more challenging the replacement of other hormones (including growth hormone).  That’s why it’s important to be monitored and managed by an experienced physician. But, for many suffering from low T the health benefits of testosterone replacement outweigh these risks. 

See “Treatment for a Low Testosterone Level”, “Nonsexual Symptoms of Low T”, “Testostereone Pellets for Men and Women”, “Testosterone Part III: Supplementation”, and “Why is Testosterone a Controlled Substance?”.







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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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