Millions of American men are using testosterone replacement therapy (TRT), with as many as 11 million men in the U.S. currently undergoing treatment. This therapy, often sought for reasons ranging from building muscle to combating fatigue and improving sexual health, carries significant risks, particularly for those intending to have children, warns Dr. Justin Dubin, a urologist and director of men’s sexual health at Herbert Wertheim Cancer Institute.
Impact on Fertility
Dubin explained that testosterone therapy can lead to infertility by dramatically reducing sperm production. The body, sensing sufficient testosterone levels, halts its natural production of sperm. This can result in a complete cessation of sperm production within three to six months of consistent use. While sperm production may eventually return after discontinuing TRT, this process can take months to years, and in some cases, may not be fully restored.
Physical Side Effects
Beyond fertility concerns, TRT can cause testicular shrinkage as the hormone-producing tubes become less active. High levels of testosterone, often a result of unsupervised or improperly dosed treatment, can also lead to adverse effects such as acne due to overstimulation of oil glands in the skin. Furthermore, the body can convert excess testosterone into estrogen through a process called aromatization, potentially causing breast development in men.
Risks Associated with Unsupervised Use
Testosterone replacement therapy is intended for individuals with clinically low testosterone levels, often associated with aging or specific medical conditions. However, studies indicate that a significant percentage of men on TRT may not meet the criteria for a prescription. Obtaining TRT through online sellers without a doctor's consultation bypasses necessary medical evaluations and monitoring. Without regular check-ups and blood work every three to six months, testosterone levels can remain abnormally high, increasing risks to cardiovascular health, including elevated blood pressure due to increased red blood cell production. Historically, concerns about TRT increasing the risk of heart attacks and prostate cancer have been raised, although recent research has challenged the link to heart events. While TRT does not cause prostate cancer, it can accelerate the growth of existing tumors, a risk that underscores the need for medical supervision and cancer screening.
Underlying Health Conditions
Dubin emphasized that low testosterone is often an indicator of other health issues. These can include lifestyle factors like poor diet, lack of sleep, and sedentary habits, as well as medical conditions such as obesity, diabetes, and cancer. Treating testosterone levels without addressing these underlying problems may not yield the desired results and can even exacerbate conditions like sleep apnea. He recommends exploring alternative treatments like clomiphene, enclomiphene, and human chorionic gonadotropin (hCG), which may help increase testosterone levels while preserving or improving fertility.