Testosterone Replacement Therapy (TRT) is a multi-billion dollar business. Seen as an alternative or complement to Viagra, testosterone pills and creams took off in the late 2000s, big time. Not surprisingly, in order to get TRT, you need to get tested. So should you go see a doctor and get tested? Perhaps not. First, we suggest considering an at-home testosterone test. But be warned, TRT may be far more dangerous than you think, so you may want to read below before ordering that first testosterone test.
Why is testosterone important?
Believe it or not, testosterone is a hormone found in both men and women. It contributes to muscle growth and development, bone health, libido (sex drive), maintaining red blood cell levels, and may play roles in improving mood and cognitive function. Because they produce more of it, testosterone gives males deeper voices, facial hair, and drives penis and testicle development, as well as sperm production.
When does testosterone start to disappear?
Low testosterone affected 20% of men in their 60s, 30% of men in their 70s, and 50% of men over 80. That’s why when you get older, you might find you get tired more easily, your sex drive lessens, you lose muscle, add fat and your bones get a bit more brittle. No surprise, though. At those ages, you don’t need to be getting your partners pregnant or competing in decathlons anymore. So, should you be thinking about testosterone replacement therapy (TRT) when you are over 60?
Come on, how bad can TRT be?
Hey, increased libido, more energy bigger muscles and easier weight loss sounds pretty damn good. Lots of women resort to hormone replacement therapy — so what can go wrong with TRT. It turns out…..a lot. Just ask the 7000 men who sued pharmaceutical companies selling testosterone supplements. Over 25,000 lawsuits were brought in the 2010s against AbbVie Inc., Eli Lilly & Co., Pfizer Inc., Endo International and other manufacturers. Cases involved popular products such as AndroGel and Depo-Testosterone, Foresta, Testim, Androderm, Testopel and Delastertryl. The plaintiffs alleged that TRT caused heart attacks, strokes or blood clots called pulmonary embolism and deep vein thrombosis. And keep in mind that in order to be a plaintiff in these cases, you had to experience these bad side effects within 90 days of using the product! None of the injuries were long-term.
For example, one of the men who sued AbbVie was Michael Gallagher, a 54-year old man. He suffered myocardial infarction, congestive heart failure and other injuries after being prescribed the gel. He had no history of cardiac problems before taking the prescription drug. Gallagher claimed he started AndroGel therapy after the defendants’ advertisements led him to attribute symptoms to low testosterone. Jeffrey Conrad went to trial in 2017, seeking damages for a heart attack caused by testosterone supplements. A jury awarded him $140 million. A similar case was brought that same year and another jury awarded $150 million. Untold numbers of testosterone therapy lawsuits have settled – all of the settlements were confidential, of course. Meanwhile, sales of testosterone boosting supplements continue to boom.
And that might be the biggest problem with TRT. There are literally no long-term studies of the effects of TRT….. in contrast to numerous credible studies showing how HRT affects women.
What are the long-term effects of TRT?
Good question. As we mentioned above, no one really knows. But here’s what we do know. Men on long-term using forms of testosterone therapy long term appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. In fact, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on testosterone replacement therapy had noticeably more heart problems.There are also signs that TRT will increase cancer rates, especially breast and prostate cancers.
The uber-credible Mayo Clinic warns that documented risks of TRT is worsening sleep apnea, overproduction of red blood cells (which raises the risk of blood clots), shrunken testicals and enlarged breasts. TRT also may also cause calcification of your blood vessels. That’s why a 2020 study of TRT for men who have heart disease strongly recommends against the treatment.
The Endocrine Society (a group representing medical endocrinologists) advises against any TRT except for the 5% of men who suffer from hypogonadism. More importantly, The Society recommends against routinely prescribing testosterone therapy to all men age 65 or older with low testosterone concentrations. And the American College of Physicians warns doctors against prescribing testosterone treatment in men with age-related low testosterone “to improve energy, vitality, physical function, or brain function.” That’s no with an exclamation point!
And, perhaps worst of all, TRT also suppresses your body’s ability to make testosterone, which can make you feel worse if you stop taking TRT.
So, still interested in an at-home testosterone test?
OK, so you are still curious as to whether you are one of the 5% of men who might benefit from TRT. Fair enough. Here are some of the companies that offer at-home testosterone test kits that you can order:
- ZRT Laboratories
- Let’s Get Checked
- Health Test Express
Most all of them have to take a sample of your saliva early in the morning when your testosterone levels are the highest. Then you mail the sample back to their lab and wait for the results.
Are the Home Kits reliable/accurate?
Hard to tell. Blood tests for male hormones are the “gold standard”. Saliva tests come in second place. For cortisol detection, they are pretty good. For testosterone, not as good. But they may well be an affordable first step. They don’t require that you go to an MD for prescribe the test. And they are not invasive, like a blood test.
There are also urine tests and blood spot tests that can be useful. All of them have pros and cons, that you can read about here. Here’s what we can say about saliva tests. If they show that you are “low t”, then you may want to use that information to justify seeing a physician and getting a blood test. However, if the tests show that your testosterone levels are normal, for your age, then perhaps you’d be better served by upping your exercise and downing fewer beers, pizza, burgers and donuts. Lifestyle changes are still the safest and surest way of boosting your T levels.