When your testosterone levels are low and you’re considering treatment, like most men your primary concern will be the side effects of TRT (Testosterone Replacement Therapy). Men often approach TRT nervously due to the negative stigma that surrounds testosterone and has for decades in the U.S. Much of the stigma is based on hysterical assumptions and science based on emotion rather than fact, but when something’s repeated time and time again it tends to make a permanent home in our mind. This raises the question, what are the true side effects of TRT? In order to answer this question, we must understand the difference between therapeutic and supraphysiological doses, and we must recognize what testosterone can and cannot do. Equally important, we must consider the effects of low testosterone and determine if those effects are worse than the possible side effects of TRT.
Therapeutic & Supraphysiological Testosterone Doses:
For the purpose of TRT, therapeutic doses of testosterone will be used. This simply means doses of testosterone will be used in order to increase your levels to their optimal state. You are not taking your levels beyond what the human body can naturally produce. You are increasing your levels because your body no longer has the ability to do it on its own. Equally important, you are doing this by introducing a hormone into your body that it is very familiar with. Testosterone is not a foreign substance to the body or one that will shock the human system. This is an essential hormone that is necessary to our health and wellbeing.
Supraphysiological doses of testosterone refer to large doses of a performance enhancement nature. The idea behind such doses is to increase testosterone levels above and beyond what the human body could ever naturally produce. The same testosterone hormone is used here as is in TRT, but the higher doses will increase the risk of side effects. The side effects of TRT are the same as with supraphysiological doses, but they are extremely unlikely with proper TRT protocol. In fact, there is no reason for any man to experience any negative side effects of TRT with proper and sound protocol.
Primary Side Effects of TRT:
The primary possible side effects of TRT surround those of an estrogenic nature. The testosterone hormone has the ability to convert to estrogen due to its interaction with the aromatase enzyme. As testosterone aromatizes, it’s converted to estrogen and as estrogen levels rise in the body, this can lead to unwanted side effects. The estrogenic side effects of TRT include gynecomastia (male breast enlargement) and excess water retention. As a secondary action, excess water retention can potentially lead to high blood pressure in some men.
In order to avoid the estrogenic side effects of TRT, estrogen must be controlled. Proper therapy isn’t simply about optimizing testosterone, but rather optimizing both testosterone and estrogen levels. If estrogen levels begin to rise, the use of an Aromatase Inhibitor (AI) like Anastrozole will offer all the protection needed. AI’s function by inhibiting the aromatase process, thereby lowering serum estrogen levels in the body. It is important that estrogen levels are not lowered too much; as men, we do need some estrogen in our body for a well-functioning and healthy body. Approximately 25-30% of all men on TRT will not need an AI as they will not aromatize a lot of their testosterone and estrogen levels will not go up, but the majority of men will. It’s impossible to predict where you’ll fall, but getting blood work done 5-6 weeks after treatment begins will give you a good idea and should determine how much AI you need. There is no need to worry about severe cases of estrogenic side effects occurring in that first 5-6 week period. You may begin to show symptoms, but no damage will be done in that short period of time. Simply have blood work done, determine your condition and then adjust your therapy accordingly to ensure the best results.
Important note – Never assume you will need an AI. If you use an AI and do not need one, you will severally lower your estrogen levels, which is extremely harsh on your overall wellbeing and health. Adequate dosing is also important. Most men on TRT will only need small amounts of Anastrozole. Common doses are 0.5 to 1mg per week. Some men will need as little as 0.25mg per week.
Androgenic Side Effects of TRT:
The testosterone hormone can potentially promote androgenic side effects due to it being metabolized by the 5-alpha reductase enzyme. This reaction causes the hormone to be converted to another androgen in dihydrotestosterone (DHT). For this reason, the side effects of TRT could potentially include hair loss in those predisposed to male pattern baldness, body hair growth and acne. Such effects are, however, strongly tied to genetic predispositions. For example, hair loss is not possible if you are not predisposed to male pattern baldness. If you are not naturally acne sensitive you will not break out. Hair growth cannot occur if hair follicles do not exist in that area to begin with; genetics are the key.
While the androgenic side effects of TRT are possible, even with the above mentioned genetic predispositions they are highly unlikely. Androgenic side effects are far more common with supraphysiological doses. In TRT, we are merely replacing what’s lacking; we are not presenting abundant amounts of testosterone to the body it is unaccustomed to. However, there are exceptions to the rule and some men may find androgenic side effects of TRT to occur, although they will be in the strong minority. But men who are extremely sensitive may have slight issues. For example, if you are predisposed to male pattern baldness you are going to lose your hair with or without testosterone use, but truly sensitive men may find hair loss occurs a little faster with testosterone use.
While the androgenic side effects of TRT are unlikely, if they do become problematic the use of a 5-alpha reductase inhibitor like Finasteride or Dutasteride can be implemented. Such medications will block the 5-alpha reductase enzyme from converting testosterone into DHT. However, such medications can create a severe androgen imbalance and should not be used unless absolutely necessary. In fact, these can be some extremely nasty medications and can rarely be advised.
Guaranteed Side Effects of TRT:
There are two guaranteed side effects of TRT in all men who undergo the practice, natural testosterone suppression and testicular atrophy. When exogenous testosterone (testosterone from outside the body) is administered, all natural testosterone production comes to a halt. When natural testosterone production goes offline, as testosterone is manufactured in the testicles, this causes the testicles to atrophy. Testicular atrophy simply refers to a loss of fullness. Your genetics will not determine the rate of suppression; suppression occurs in all men.
For the low testosterone patient, natural testosterone suppression is of no concern; after all, he doesn’t produce enough testosterone on his own to begin with. In this case, we are merely shutting down what’s already inadequate production. As for testicular atrophy, this is merely a cosmetic concern and presents no damaging effects to our health. However, it can also be avoided. The use of HCG will keep the testicles from shrinking as it will simultaneously keep what natural testosterone production you have going while supplementing with exogenous testosterone. This is not the only benefit of HCG, far from it, but it’s one that makes many men far more comfortable with TRT.
An important note – HCG will only protect against testicular atrophy in men who suffer from secondary hypogonadism. Men who suffer from secondary hypogonadism, their testicles still function but the Luteinizing Hormone (LH) signal from the pituitary isn’t getting there, normally due to inadequate amounts of LH. As HCG is in simplistic terms synthetic LH, this solves the problem. However, for the man who suffers from primary hypogonadism, his testicles no longer have the ability to produce testosterone regardless of the pituitary releasing abundant amounts of LH. HCG will not work for the man suffering from primary hypogonadism. For this man, he will simply need to accept testicular atrophy (it’s not dramatic) or he will have to live with low testosterone. For most men who suffer from primary hypogonadism, typically their testicles have already experienced a bit of atrophy despite no TRT.
The Side Effects of TRT vs. Low Testosterone:
When looking at the side effects of TRT, in order to determine if such possible effects are worth undergoing treatment, you must consider the effects of low testosterone. Would you rather risk the side effects of TRT, which are easily avoidable, or would you rather live with a low testosterone condition? We’ve discussed the side effects of TRT, but let’s take a look at the symptoms of low testosterone:
- Erectile Dysfunction: Can refer to weak erections, the inability to maintain an erection or the inability to obtain an erection.
- Loss of Libido: This refers to a diminished desire for sexual activity. Many men who suffer from this often suffer from erectile dysfunction and seek out medications like Cialis and Viagra. Such medications do wonders for erectile dysfunction but do nothing for libido.
- Loss of Muscle Mass: Despite no changes to diet, exercise or lifestyle.
- Loss of Strength: Despite no changes to diet, exercise or lifestyle.
- Increased Body Fat: Despite no changes to diet, exercise or lifestyle.
- Loss of Energy: The body needs testosterone in order to repair itself and rejuvenate. Without adequate testosterone it takes more energy to repair and leaves you with less energy for daily task. Many men will also find it takes much longer to recover from physical activities than it used to.
- Loss of Mental Clarity and/or Difficulty Focusing: Our brain needs testosterone to function. Without adequate testosterone, brain function begins to diminish.
- Depression: See Loss of Mental Clarity – Many men also become depressed due to the other mentioned symptoms.
- Other Common Symptoms: Insomnia, high cholesterol, irritability, lethargy, difficulty coping with stress, mood swings and general unhappiness and a lack of fulfillment in life.
It’s not hard to see that the symptoms of low testosterone far outweigh the side effects of TRT, especially when we consider the side effects of TRT are so easy to avoid. However, we’ve only touched the surface, it gets worse. Those who ignore their low testosterone condition increase their chances at conditions that are far more damaging. Long term low testosterone has been linked to Alzheimer’s Disease, heart disease, osteoporosis and diabetes. Still think the possible side effects of TRT are too great of a risk?