Is Testosterone Replacement Therapy Actually Safe? Velocity Health’s CDO Weighs In.
By Brock Reichert, Velocity Health’s Clinical Operations Director
Perhaps one of the most controversial topics in the world of medicine today is the use of exogenous testosterone as treatment for hormone imbalances, whether in mild cream-based doses or in injectable form. There have been many debates among medical professionals about this topic, and every discussion seems to be very polarized. Should testosterone be considered a steroid or a medication? Does it promote longevity, or does it cause patients to age faster? Is it good for your heart, or does it increase your risk of heart attack? This sort of discourse can leave many wondering: Is testosterone even safe to use?
I just had a conversation with a good friend of mine who met with his doctor recently. He had asked his doctor very frankly about the possibility of him starting testosterone replacement therapy (or “TRT”) and he was left disappointed when his doctor sheepishly admitted that, despite being willing to check labs and other health markers outside the normal scope of traditional medicine, he was not able to prescribe testosterone, even if my friend’s testosterone levels were debilitatingly low.
In my opinion, TRT’s safety is a nuanced topic. In the following sections, I will do my best to address the benefits and concerns regarding testosterone use, based on my experience and research as a clinician.
Let’s cut to the chase: Is TRT safe or not?
I believe strongly that TRT is safe.
As recent as 2023, the Lancet journal published a study that conducted the biggest randomized controlled trial to date on testosterone use. It studied over 5,000 men, ages 45-80, who take testosterone, and it ultimately showed no additional risk with testosterone use versus the placebo.
Now with this in mind, let’s talk about two of the most commonly-cited reasons as to why so many traditional clinics are still hesitant to permit TRT prescription.
Potential Health Concerns of TRT
Increased red blood cell count
Regarding testosterone injections specifically (not cream-based application), one of the major concerns medical professionals often cite is the increase in red blood cells it can stimulate. This increase is caused by a spike in Erythropoietin (a hormone that stimulates red blood cell production in your bone marrow). The exact reason why testosterone injections cause a spike in Erythropoietin is unknown as of now, although some medical professionals believe it is due to the injection’s activation of progenitor cells.
This increase in red blood cell count is certainly a concern, though it does not affect most TRT users. The older you are and the higher your injection dose is, the higher your possibility of having an increased red blood cell count.
At Velocity Health, we take a very nuanced approach to TRT, and we monitor and intervene as necessary when high red blood cell counts occur. When monitored in this way, I don’t believe high red blood cell count to be something a TRT patient would need to worry about.
Increased prevalence of blood clot formation
There is also concern over testosterone injections causing blood clots like DVTs (deep vein thrombosis) and PEs (pulmonary embolism). There is decent evidence that there is a mild increase in these events in testosterone users, although the risk is still low. This is another reason we at Velocity always mitigate and screen for additional risk factors prior to starting therapy, something a lot of TRT “pillmills” don’t take into consideration.
Now that I’ve discussed a couple of the risks often associated with TRT and why I don’t believe them to be a concern for the majority of its users, I will move on to discussing its benefits.
Benefits of TRT
At the time of this writing, there have been multiple papers written on the all-cause mortality reduction with the use of testosterone in hypogonadal men. Long story short: men taking testosterone reduces their chance of dying.
And to touch on the cardiovascular scare I mentioned briefly, which kept clinicians from prescribing testosterone for so many years, evidence demonstrates that having LOW testosterone is actually a risk factor for heart attacks and strokes. This is a big swing from the medical dogma still held by many.
There are countless health factors that testosterone can improve, including reducing risk of metabolic diseases such as type 2 diabetes, promoting weight loss, and increasing energy levels and sex-drive. For me, another benefit here would be the “snowball” effect, where people who experienced the aforementioned effects of testosterone find themselves in a momentum state with their health and want to continue improving in other areas of their lifestyle.
But…TRT in only one piece of the health puzzle
To finish off, I want to stress that, while I take a pro-TRT stance, I do not believe that testosterone injections are the solution to all health problems. TRT is not some catch-all, magical fix for low energy, low sex drive, and overall poor health. But, in some cases, it can be the first step in that wave of change that creates major alterations in a patient’s health.
It’s important to remember that your hormone levels are only the end products of a long health story in your body. When we prescribe treatment at Velocity Health, we don’t just look at a patient’s low testosterone levels in isolation. We re-trace their body’s steps to find out what is causing low testosterone in the first place, which could be a poor diet, lack of exercise, or a large number of other factors. For many of our patients who come to us with low testosterone, TRT may not even be a necesssary step to take in order for them to re-gain their vitality and well-being.
Want to know if TRT or another precision health strategy is right for you?
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