Testosterone replacement therapy: Yes or no

Tired? Low sex drive? Problems sleeping? Wouldn’t it be nice if there was an easy answer to these common problems often caused simply by aging?

For men, one solution promoted by drug advertisers is testosterone replacement therapy. Having low testosterone even has its own snappy name: Low T.

But as the use of these medications increases, so do concerns about possible harm if they’re taken unnecessarily.

The Food and Drug Administration requires prescription testosterone replacement therapy products be clearly labeled to inform men about a possible increased risk of heart attacks and stroke.

So is low “T” a real thing? And when is it OK to embark on testosterone replacement therapy?

What is testosterone?

Testosterone is the male sex hormone made in the testicles. It is what makes a boy’s voice drop lower and facial and other body hair grow. It is also necessary for male sexual functions like erections and the production of sperm.

If you are not producing enough testosterone it can lead to several symptoms:

• Low sex drive
• Erectile dysfunction
• Fatigue
• Reduced muscle mass
• Depression
• Irritability

Testosterone replacement therapy usually comes in the form of patches, injections, pellets that are implanted under the skin or gels. Testosterone cannot be given in pill form because the liver breaks it down very quickly.

Who should use testosterone replacement therapy?

Our experts say there are many people who would benefit from testosterone replacement therapy. If you have had a serious medical treatments like chemotherapy or radiation, or you have injured a testicle, you may need testosterone replacement therapy.

But taking it to solve problems with fatigue, low energy or sinking sex drive without a full check-up can mean the real causes of these symptoms are overlooked.

“There are a lot of reasons why you could have low testosterone. Assessing it in the right way is essential,” says Conor Best, M.D., assistant professor in Endocrine Neoplasia and Hormonal Disorders at MD Anderson Cancer Center.

Testosterone should be checked at least twice using a blood test. Both tests should be done in the morning between 7 a.m. and 10 a.m.

If the tests do show a low level, you should discuss the possible causes with your doctor before deciding if testosterone replacement therapy is right for you.

Diabetes and obesity, as well as increasing age, can lead to low testosterone.

“If there’s no clear cause for low testosterone, working on your diet and increasing exercise can often be the answer.”

What about herbal supplements that claim to boost testosterone?

Over-the-counter supplements for testosterone generally do not contain any of the hormone. Manufacturers claim that the herbs and minerals in them will increase your natural production of testosterone.

But our expert says there is no herbal supplement that will reliably increase testosterone.

And over-the-counter supplements are not regulated. This means that the ingredients in them are not checked, so supplements might include more than what is written on the label, or less.

“We are concerned that an unregulated supplement that ‘boosts testosterone’ could have potentially toxic versions of testosterone in it, or another medication with unintended side effects,” says Best.

If you are concerned about your testosterone level, the best thing to do is talk to your doctor and get properly tested.

Risks of taking testosterone

In addition to masking the underlying problem, testosterone supplements come with their own risks.

Testosterone replacement therapy can lead to blood clotting problems because they cause the body to make more red blood cells.

Excess testosterone can turn into estrogen, which comes with risks. Extra estrogen also can lead to blood clots. And it can cause breast tissue to develop, which puts you at a higher risk of male breast cancer, although this risk is small.

Problems with heart disease have also been seen in some large population studies, which led to the FDA warnings about heart attacks and strokes.

 “We’re still learning new things about what all these hormones do. You can’t always predict what the downstream effects will be,” says Best.

“If someone has a pretty normal level, maybe supplementing does potentially do more harm because you’re overriding the body’s natural state.”