Testosterone Replacement Therapy is meant for men and women who have low testosterone. Can we approach Low T treatment in such a way that allows for minimization of side effects while allowing for optimization of results? Your body metabolizes testosterone into estradiol, a form of estrogen. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting. Your provider is there to support you in all aspects of your health. If symptoms of low testosterone are interfering with your quality of life, know that you don’t have to just grin and bear it. For all these reasons, your healthcare provider will carefully consider if TRT is safe for you based on your unique characteristics. This is why healthcare providers do extensive evaluations and tests before approving the use of TRT. Your body will take some time to restart production of testosterone naturally. Had these men not initiated TRT and not underwent regular testing of their PSA level, these cancers may have gone undetected for years. In fact, we check them so regularly that we can find evidence of an abnormality much sooner than it otherwise may have been detected. Any significant elevation of PSA levels indicates the need for a thorough examination to determine the cause. Values can shift with assay method, time of day, dosing formulation, time since last dose, illness, and body composition. The AUA uses below 300 ng/dL as a reasonable diagnostic cutoff, but treatment targets are individualized and generally aim for physiologic replacement rather than one universal number (Mulhall et al., Journal of Urology, 2018). A more personalized, proactive partnership should protect against over-treatment just as much as under-treatment. That is why good hormone care depends on more than a screenshot of a lab result. In transdermal therapy, timing matters differently. One reason lab conversations around TRT become confusing is that testosterone values are not independent of timing. In younger men, some authors have argued that a one-size-fits-all cutoff may miss clinically relevant low values when symptoms are present. There aren’t a lot of guarantees, but reasonable measures can be taken to lessen the negative impact that exogenous testosterone and TRT has on fertility. If having a family in the traditional manner is still a goal for you, holding off on treatment for a period of time is one option. However, for men who do not want to risk not being able to father a child, banking sperm before starting TRT makes sense. Studies have shown that sperm count often returns to normal several months after stopping Testosterone Replacement Therapy. If you and your partner are hoping to expand your family in the near future, it may be necessary to look at other possible avenues of Low T treatment that will maintain sperm production. On the other hand, there is a risk that TRT will adversely affect fertility. In other words, we interrupt the process of sperm production by introducing additional testosterone into the biochemical equation. Hormone levels fluctuate, so it’s important to administer correct doses to keep your testosterone in the optimum range AND in balance with your other hormones. We think our findings offer some reassurance to doctors and patients that testosterone replacement therapy does not increase the risk of heart problems. These supplements can complement testosterone therapy, support metabolic health, improve energy and recovery, and help optimize overall wellness when used under provider guidance. Normal levels of testosterone may be achievable with hormone therapy and lifestyle adjustments.
