Testosterone replacement therapy: Pros and Cons

Last updated: March 6, 2024

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There are lots of patients who suffering from testosterone deficiency syndrome (TDS) whom need testosterone replacement therapy at my andrology office. As we know that testosterone hormone represents as a well-being status in male, an adequate testosterone that we have mirroring the more youth-like as the gentlemen shall be. Testosterone level will be peaked at the age of 30 then gradually decline for 1% down per year. The general ideas on testosterone functions have been played a main role in erectile function such as sexual desire and stabilize mood controlling for men.

As we already know that everything has pros and cons, and you should have known it prior starting testosterone replacement therapy. Let’s have look on them.

Pros of Testosterone replacement therapy

1. Improves on sexual desire and erectile dysfunction – Amount of circulating testosterone absolutely relates to the libido level and erectile function. As the recommendation, we should try a short course of testosterone therapy in new case before using long duration regimen.

2. Increasing mineral bone density
3. Increasing muscle mass and decreasing fat mass
4. Stabilize mood, improving well-being and fatigue – TDS sometimes has been called as a men-menopausal because testosterone playing a mail role in mood stabilization. Adequate testosterone therapy will improve all the men-menopausal-liked symptoms.
5. Preventing dementia – An interesting literature from the US shows that a higher testosterone level, the less likely risk of Alzheimer’s disease.
6. Improving on diabetes mellitus and cardiovascular disease – Testosterone replacement therapy play a main role in insulin resistance modulation and decreasing risk of metabolic syndrome.

Cons of Testosterone replacement therapy

1. Might worsening benign prostate hyperplasia (BPH) – BPH is a degenerative prostate disease which will improve with a lower active testosterone level. In contrast, the raising testosterone therapy might worsen its symptom.
2. Worsening prostate cancer – It is a contraindication of testosterone replacement therapy using in prostate cancer due to this therapy will directly make prostate cancer be more aggressiveness. That’s why we must do a prostate cancer screening test for all gentlemen before starting the therapy.

3. Risk of a higher concentrated circulating red blood cell – So called “Polycythemia”; testosterone therapy will directly stimulating red blood cell production resulting to a pro of increasing more oxygen to end organ. But if it is too much concentrated might be a problem, for example higher risk of thrombosis. That’s why we will do regular blood test during on testosterone therapy.
4. Excessive libido and aggressiveness – From over circulating testosterone level but rare.
5. Female-liked breast – So called “Gynecomastia” in long term of using
6. Testicular size reduction and compromised fertility – This con will affect around 10 weeks after starting the therapy and will be back to normal when stop the therapy for 18 months.

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