Interviewer: Testosterone therapy, generally speaking it's safe, but there are some side effects. What do you need to know? Why is it important to have a doctor part of your treatments and not just buying it off a TV ad? We'll talk about that next on the scope.
Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier healthier life. You're listening to The Scope.
What are the Risks of Testosterone Treatments?
Interviewer: If you're on testosterone treatments, it's important to be regularly monitored by a physician to avoid potential risk. Dr. Jim Hotaling is a urologist and a men's health expert at University of Utah Health Care.
So let's say I'm a man. I saw the TV ad for testosterone treatments and now I'm taking them. Are there some possible risks?
Dr. Hotaling: I mean I think the biggest thing we see very frequently, and I define frequently as I probably see one to two guys a week with this, is that testosterone will make men sterile. It's actually been trialed as a male birth control. It only works on about 90, 95% of men. So it didn't actually make it as male birth control. But that's the biggest thing. It will drop your sperm count to zero in most instances.
Raised Red Blood Cell Count
The other issue is that it can raise your red blood cell count in some men to unsafe levels. Particularly the injections can do that. It can also cause fluid retention. Theoretically we used to think that it would increase your risk of prostate cancer. But there really isn't a lot of data to actually support that.
Increased Risk of Stroke or Heart Attack
And then there's been a lot of data about cardiovascular disease, testosterone and increasing the risk of stroke or heart attack. That really as it turns out, the major study that sort of showed that, which is a paper in a very prominent medical journal, has been shown to be methodologically flawed in a number of different things. And actually there's a lot of data that shows that men with testosterone actually do better from a cardiovascular disease standpoint.
I think generally speaking it's a very safe drug as long as things are monitored appropriately. We check labs on our patients every three to six months for the first year and then annually thereafter. Generally speaking we have very few, if any, adverse events from men being on it. So that in a nutshell are what the major concerns are.
Is Testosterone Treatment Dangerous?
Interviewer: So the people that are probably the target for the television commercials tend to be older. So they might not be concerned about their child rearing days are done. Are there dangers? I always understood that there just wasn't enough research to say whether or not it's safe at this point. And I hear a lot of comparisons to estrogen treatments in women.
Dr. Hotaling: Yeah, so there have been some huge trials done on estrogen treatments. One of the big issues is with that is increasing the risk of blood clots.
Testosterone treatments actually raises estrogen levels in men as well. And that can be an issue. That can get to an unsafe level especially in overweight men. Their fatty tissue has an enzyme in it that will convert testosterone to estradiol which is a female hormone and that can get to unsafe levels.
I think the big issue with testosterone is that we have patients who have been on testosterone for 5, 10, 15 years and we don't have follow up. We don't have the research to know what the exact effects are for being on it for that long. We think generally speaking it's very safe as long as it's used in a reasonable and measured fashion.
Importance of Speaking to your Doctor
Interviewer: So originally in this conversation I was going to take it in the direction of, somebody saw the ad on TV, they're getting the creams in the mail now and I was thinking it's a dangerous thing. But it sounds like you're saying it's not a dangerous thing.
Dr. Hotaling: I think if it's monitored appropriately and men are on it for the right reasons, I think it can make a big difference in their quality of life.
Interviewer: So if I was on it because of a TV ad, it's a good idea at some point to go to a urologist and have some labs done.
Dr. Hotaling: Yeah, definitely. We see a lot of people who are not really appropriately managed. There's a lot of these testosterone clinics that never see the patient and maybe have a phone interview and I think if men are on testosterone they need to see a physician regularly, have appropriate labs monitored, and know that it can make them sterile.
I would say no man of reproductive age who is planning on having children in the future should be on testosterone. There are alternatives that we can use that men have low testosterone and symptoms that are of reproductive age and can boost their testosterone and actually improve, not hurt their fertility.
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