Testosterone Replacement Therapy: The risks and benefits of the controversial therapy

The Mayo Clinic explains that testosterone levels usually peak during adolescence and early adulthood. Signs that some individuals may notice as levels decline, combined with the effects of natural ageing, includes changes in sexual function, physical changes and emotional changes. Declining testosterone levels can also be a sign of hypogonadism – a disease that disrupts the ability to produce normal amounts of testosterone, due to a problem with the testicles or with the pituitary gland that controls the testicles. For both of these reasons, many men turn to TRT.

It is possible that TRT can help to reverse the effects of hypogonadism, but it remains unclear whether the therapy benefits older men who are otherwise healthy, but are just experiencing natural drops in testosterone.

According to Harvard Health, TRT can also produce long-term side effects, including a higher risk of cardiovascular problems and an increased risk of prostate cancer due to the therapy stimulating the growth of cancer cells.

In order to explore this further, Prostate Cancer UK spoke exclusively to Express.co.uk to try and demystify the concerns surrounding TRT.

Dr Hayley Luxton, Research Impact Manager at Prostate Cancer UK said: “Testosterone Replacement Therapy can be useful for men dealing with problems caused by low testosterone.

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“Low levels can contribute to issues like depression, difficulty sleeping, fatigue, or a lower sex drive.

“However, when using TRT, the body stops making its own testosterone, and it can take some time for the body to start producing it again, making it hard to stop the treatment. There are also strong links between the use of TRT and an increase in heart conditions.”

WebMD goes a step further, reporting that TRT has multiple associated side effects including:

  • Acne or oily skin
  • Mild fluid retention
  • Stimulation of prostate tissue, with perhaps some increased urination symptoms such as a decreased stream or frequency
  • Increased risk of developing prostate abnormalities
  • Breast enlargement
  • Increased risk of blood clots
  • Worsening of sleep apnea
  • Decreased testicular size
  • Increased aggression and mood swings
  • May increase risk of heart attack and stroke.

The Journal of Clinical Oncology released a paper that tried to examine the link between TRT and prostate cancer further. In a study at the National Prostate Cancer Register of Sweden, 284 patients who had all been diagnosed with prostate cancer and 1,378 control cases filled out prescriptions for TRT.

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Results found that patients who had received TRT had a more favourable risk of prostate cancer, but a lower-risk of aggressive prostate cancer.

This means that those patients who received TRT did not have an increased risk of overall prostate cancer, and a longer duration of adherence to TRT was not associated with greater risk.

The term “favourable risk” relates to individuals who possess only one of the immediate risk factors of the condition.

Individuals usually have a PSA level between 10 or 20ng/mL, and the tumour is confined to the prostate area. Unfavourable intermediate-risk prostate cancer is defined as the presence of two or more intermediate risk factors. These factors include a PSA level of 10 to 40 ng/mL, a Gleason score greater than seven, or a high fraction of prostate biopsies showing cancerous cells.

The study ultimately concluded that from a prostate cancer perspective, TRT is safe in hypogondal men, but admitted that due to a lack of data on circulating testosterone levels, the connection between changes in hormone levels and prostate cancer risk was near impossible to evaluate.

When asked her opinion on the connection between prostate cancer and TRT, Dr Luxton said: “There is not yet enough evidence to say that it has any impact on your likelihood of developing prostate cancer.

“We would need to see more studies with large, diverse groups of men before we make that link.

“This treatment has also been linked to a number of heart conditions, so anyone considering this treatment should have a discussion with their GP about what is right for them.”

The Men’s Health Clinic agrees, stating that studies are increasingly demonstrating no increase in prostate cancer incidence among men on TRT; furthermore, no discernible increase in disease progression in prostate cancer on TRT has been observed.

The site goes on to explain that an often overlooked fact is the role that oestrogen has in males. In studies that use both testosterone and oestrogen, prostate cancer was caused in 100 percent of the cases, suggesting that it is in fact oestrogen that plays a part in the development of prostate cancer.

Gathering evidence together it seems that TRT is beneficial to those individuals who suffer from hypogonadism, especially younger individuals. However, there are strong links to suggest that the therapy can cause a number of heart conditions.

Anyone wanting to try TRT, but has questions concerning whether it is the right choice for them should talk to their GP, and also be sure to have regular follow-up appointments with your doctor after beginning a course of TRT.

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