Safety of Testosterone Replacement Therapy in Andropause

Summary: Testosterone replacement therapy is a viable option for a lot of patients.  Because testosterone is a hormone there can be a lot of side effects.  However, you must implement lifestyle modifications to maximize the effect of the testosterone supplementation.

Dear Curtis: I’m almost 60 years old and I’m getting a lot of the signs and symptoms of low testosterone.  My doctor said this is andropause and that my only viable option is testosterone replacement therapy.  I’m almost ready to pull the trigger but, is it safe?

I’ll repeat a mantra of mine…”when you take a hormone lots of things can happen”.  Testosterone might be the poster child for this as their can be a lot of good effects and bothersome side effects.  But it really depends on you and where you are at right now. Also, what you get out of taking testosterone depends a LOT on your lifestyle.

First, Some Background

You’ve mentioned your 60 and you and your doctor feel that you have a lot of the signs and symptoms of low testosterone.  That’s no surprise.  After age 40 most men see a significant decline in their testosterone levels.  I say ‘most’ because there are some men who maintain youthful testosterone levels into what you and I might consider ‘old age’, seventy and above.

How you ask?  It’s really a combination of things but the main point is how their healthy eating style.  They eat NO processed foods which are infamous for containing estrogen-like compounds.  They consume fats and proteins in their diet which is the building block for testosterone.  They employ reasonable exercises, including compound exercises that recruit large muscle groups like the squat, dead lift and pressing exercises.  They get better sleep.  They have reasonable alcohol consumption (overdoing it on alcohol quashes testosterone production).  Their body fat is low.  Originally this a byproduct of having good testosterone levels in the first place.  But the more fat you have the more estrogen you’ll likely produce as fat can convert testosterone to estrogen. They minimize stressors in their lives.

Also, these men generally take part in some sort of ‘competition’. It doesn’t have to be sports. It can even be board games. But they take part in something that really gets their competitive juices flowing which helps keep testosterone levels up.

All of these factors either support testosterone production or promote testosterone being converted to other substances like estradiol and estriol – ‘female’ hormones.
And, in the vast majority of men, that is what happens and what is likely happening to you.  As your testosterone levels decline men become estrogen dominant.  Skinnier arms, less muscle mass, more abdominal weight, lack or lowering sex drive, depression and just less ‘zest’ for life in general.

So obviously, I’d talk to your doctor first and foremost about instituting lifestyle changes that will maximize your circulating testosterone now and prevent more from being converted to estrogen products.  This is, of course, assuming that your are still producing your own testosterone and haven’t succumb to hypogonadism.  Which, as the name implies, is when your gonads (testes) stop producing testosterone either from their own dysfunction or from a dysfunction in your brain (secondary hypogonadism) through feedback loops.

In short, even when you supplement with testosterone, you must have lifestyle modifications. If you don’t you still may not see your testosterone levels rise. Here’s why.

Testosterone Replacement Therapy: What You Might See

Here is a detailed testosterone synthesis chart (opens in a new window).  What this is showing you is how testosterone is made in your body (90% in your testes).  You can also see something I was talking about above.  Once your body makes testosterone (from cholesterol) a few things can happen.  Your body can use it.  It can be converted to dihydrotestosterone (DHT) or it can be converted to estradiol and eventually estriol.  These are ‘estrogens’.  And yes, men need some estrogen just like women need testosterone.

But, generally as American men age they become estrogen dominant.  This is bad.

You first need to understand how testosterone acts in your body to appreciate what replacement therapy will do for you – both good and bad.

Whether you take testosterone injections, gel or patches your body will likely recognize this outside source of testosterone and essentially back off what it is producing in your own testes (if there still is production).  So, there could be testicular shrinkage.

Secondly, what is your body fat level?  And be honest.  If it’s high enough you’ll likely discover that although you are supplementing with testosterone your free testosterone levels don’t rise accordingly.

This is likely due to aromatization of testosterone.  Body fat stores allow this to happen.  Actually, this may be part of the problem in the first place. It also explains why some men can get testosterone supplements and their levels of circulating testosterone don’t increase.

Once that testosterone is aromatized it is converted to estrogen.  You then may experience what recreational steroid users refer to as ‘bitch tits’.  This is estrogen’s feminine side rearing it’s head.

Compound this with a high intake of xeno- and phyto-estrogens from the environment and soy products and you can understand why many young men nowadays are walking a fine line with feminism…literally.

On the flip side, testosterone is known as the feel good hormone.  So you may have your drive for life and sex.

Other Caution with Testosterone Replacement Therapy

  • Hepatitis
  • Worsening of Sleep Apnea
  • Reduced ejaculatory volume
  • Cholesterol level changes
  • Edema

“Roid’ Rage”

I’m sure you’ve heard the dreaded stories about ‘steroid’ users who have a roid rage and attack someone during rush hour traffic.  Don’t.  The doses that these kind of knotheads take are called supraphysiological.  In short, they are far beyond any dose that humans should be taking.

If a man has a healthy testosterone level there will be – as I mentioned above – a healthy zest for life.  A good sex drive.  But not any type of roid rage.

Prostate Cancer

Ten years ago your doctor probably would have been very reluctant to prescribe any sort of testosterone treatment because we all thought testosterone was the root cause of prostate cancer.  In fact, my grandfather passed away from prostate cancer in 1998.  And, at that time, testosterone was the culprit – or so we thought.

But, if that’s the case, why don’t more 20 year old men get prostate cancer?  Men who are absolutely filled to capacity with testosterone.  So obviously there are other factors at play.  In fact, in some countries they are now using testosterone to treat certain prostate cancers.

In short, unless you already have prostate cancer or some sort of prostate problem like Benign Prostatic Hypertrophy I wouldn’t concern yourself too much with replacement therapy.

In Summary

As you can see, the decision to implement testosterone replacement is far from simple. There are so many variables at play. And, while I’ve only known a few men who were clinically diagnosed as testosterone deficient I would suspect that many men today are, they just don’t know it.

I would encourage you to talk to your doctor about natural testosterone replacement.  Not necessarily through pills or so forth (you’ll simply run into the same problem that you did with prescription testosterone replacement).  But through lifestyle modifications.

Frankly, most men are the sole cause of their low testosterone.  Once you have exhausted those options (and there are many) you can look into supplementation and replacement therapy.

Most men I know who take testosterone feel better on it. Additionally, at 60 years of age, prescription testosterone replacement may be the only viable way to increase your testosterone blood levels.  With lifestyle modifications that I talked about above it will help you body ‘hold onto’ the testosterone better.


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