Illustration by The Globe and Mail. Sources: iSt
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
In the last few weeks, I have been asked about testosterone replacement therapy (TRT) at least once a day by my male patients. As cultural attitudes around men’s health shift and awareness grows about low testosterone, more men are asking about their levels and whether treatment could help them feel better. They’re realizing they don’t have to suffer through symptoms such as fatigue, low libido and decreased muscle mass – but can instead seek effective treatment.
However, it’s important to note that treatment is not pursued indiscriminately. Doctors now recognize the need to approach testosterone deficiency with the same clinical rigour as other hormone deficiencies, such as hypothyroidism. Indiscriminate use – such as borrowing testosterone from a friend at the gym – is increasingly common but medically inappropriate and potentially harmful.
If you’ve been wondering what TRT is and whether it might be right for you, here are some key things to know.
What is testosterone deficiency?
Testosterone is the main male sex hormone, responsible for the development of male reproductive tissues and male sexual characteristics (e.g., body hair, deepening voice), and for the maintenance of muscle and bone mass.
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Testosterone levels naturally decline with age. However, when levels drop excessively below normal, men may experience what’s known as testosterone deficiency, also called hypogonadism or testosterone deficiency syndrome. According to the Canadian Men’s Health Foundation, men in their 70s or older have a higher chance of developing it than men in their 40s or younger.
Testosterone levels in the body can also decline owing to some chronic illnesses or medical conditions, including Type 2 diabetes, obesity, HIV/AIDS, and kidney or liver disease.
How is it diagnosed?
Men with symptoms such as low libido, fatigue, depressed mood and reduced muscle strength should be evaluated with a blood test that measures testosterone levels. (Contrary to popular belief, erectile dysfunction is not a common early-stage sign of testosterone deficiency.)
Since testosterone levels are highest in the morning, bloodwork should be done in the mornings. If levels are found to be low, a repeat test is necessary to confirm consistent deficiency.
What is TRT and what does it do?
Testosterone replacement therapy aims to restore testosterone levels to a normal range in men who are both symptomatic and biochemically confirmed to have low testosterone. Benefits include improved libido, mood, energy levels, muscle mass and overall quality of life.
TRT can be administered in various ways, including by injections, gels, patches and pills.
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As with many medical treatments, there are benefits and potential risks for patients to consider.
Benefits may include improved libido, increased energy and physical strength, and better mood and mental focus.
Potential risks include acne, male breast tenderness, suppressed sperm production with possible fertility issues, and worsening of sleep apnea. In some cases, TRT can also lead to increased red blood cell count, which may increase the risk of blood clots.
Concerns about TRT increasing the risk of prostate cancer or cardiovascular events are often cited, but large observational studies have shown little definitive evidence of harm.
TRT is not uniformly covered by provincial health plans in Canada. This financial barrier may limit access, especially for those without extended health benefits.
What to discuss with your doctor
If you think low testosterone may be affecting your health, it’s important to have a structured conversation with your doctor. Consider asking:
- Are my symptoms consistent with testosterone deficiency?
- What lab tests will confirm this?
- What other lifestyle modifications might help? (Weight loss, strength training, getting proper sleep, reducing alcohol or recreational drug intake, and generally pursuing a healthier lifestyle can boost testosterone levels naturally.)
- Do I have any medical conditions that are not compatible with TRT?
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It is also important to note that TRT suppresses the body’s natural production of testosterone, and this may not be immediately restored after stopping treatment.
When done safely, TRT can be an effective treatment for properly diagnosed testosterone deficiency, offering improvements in sexual function and quality of life. But it is not a one-size-fits-all solution and some patients – for example, those with untreated heart failure or prostate cancer – may not be eligible for treatment.
Speak with your doctor to make sure your personal health considerations are taken into account and appropriate testing is done before starting treatment, and that your testosterone levels are monitored regularly if you choose to start TRT.
Dr. Yan Yu is a family physician in Alberta and the Northwest Territories and the founder and director of Joyce Health, an online child and adolescent psychiatry clinic. He works in a wide range of clinical settings, including in rural and remote communities, and creates medical education videos in his spare time.
