TRT: Separating Myths And Truths
Over 40% of men over the age of 40 suffer from symptoms of low testosterone levels such as low sex drive, erectile dysfunction, lack of energy, depression, and an increase in body fat. Should men experiencing these symptoms write them off as symptoms of aging, or should they investigate whether they have low testosterone? Men can buy testosterone injections, one type of testosterone replacement therapy (TRT), online with a prescription, should they?
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Questions such as these are discussed across the internet, and opinions vary. Some healthcare providers are uncomfortable with prescribing testosterone replacement therapy, while others see no difference between treating the symptoms of low testosterone and the symptoms of high glucose. They know the risk of type 2 diabetes increases with age and can cause symptoms leading to serious disease or death if blood sugar levels are not brought under control. The adverse effects of not supplementing with testosterone if a man has low-T levels due to aging are not as well explored, but more and more clinical trials are separating the myths from the facts. These studies are overwhelmingly in support of treating low testosterone levels in men with laboratory evidence and symptoms of low testosterone levels.
How Does Testosterone Act In The Body?
Testosterone affects tissues and organs throughout the body. Testosterone increases bone strength, increases red blood cell production, drives sexual function and libido, increases muscle strength, and helps protect the heart (Gruenewald et al. 2003). Hormones, such as testosterone, travel through the blood and can have effects on tissues and organs throughout the body. As you might have experienced, the effects of low testosterone on the body may be more widespread than at first glance. For this reason, according to Dr. Ludlow (2015), a urologist, the benefits of testosterone replacement therapy far outweigh the risks.
LH and FSH are hormones released by the brain that stimulate Leydig cells in the testes to produce testosterone. The production of testosterone is pulsatile and diurnal, with the highest production in the morning. Testosterone is carried through the blood, either bound to sex hormone-binding globulin or albumin. A small amount of testosterone is free in the blood. Only testosterone bound to albumin or free in the blood can bind to receptors on the surface of cells and bring about an effect.
Testosterone is a product of cholesterol metabolism. A small amount of testosterone is converted to estradiol because estradiol is necessary for the male, just like a small amount of testosterone is needed in the female. Estradiol is protective for bone health and maintaining good cholesterol levels.
Some testosterone is converted to dihydrotestosterone (DHT), a more biologically active form of testosterone. Irradiating or removing the prostate gland adversely affects the conversion of testosterone to DHT.
The endocrine system is one of the most complex systems in the body. Hormones are converted from one form to another, and they interact with each other. A change in one hormone level can have unforeseen effects.
Why Does Testosterone Go Down With Age?
As men age, there is a decline in testosterone production and an increase in sex hormone-binding globulin (SHBG). Both a decrease in testosterone production and an increase in testosterone bound to SHBG decrease the amount of free testosterone in the blood (Basaria & Dobs, 1999). Free testosterone and testosterone bound to albumin are the only forms that can interact with androgen receptors throughout the body, bringing about an effect.
Most labs are unable to measure free testosterone levels directly. Instead, it is a calculated number. Albumin levels, sex hormone-binding globulin levels, and free testosterone levels are not static numbers. Changes in lifestyle factors, diet, and other medical conditions can cause changes in these levels, which are not exclusively due to low testosterone production. The complexity of interpreting these lab values is why men who buy TRT (testosterone injections) online need to have a thorough medical exam, have their lab values evaluated by a healthcare provider, and receive a prescription for the appropriate form and dose of testosterone before they get testosterone replacement therapy online.
Can Other Diseases/Disorders Affect Testosterone Levels?
Thyroid disease, obesity, and some liver-related disorders can affect testosterone hormone levels. Aging, hyperthyroidism, and using anticonvulsants and estrogen can all elevate sex hormone-binding globulin, which decreases the amount of bioavailable testosterone. Hypothyroidism, obesity, increased prolactin secretion, excess growth hormone production, and type 2 diabetes can decrease SHBG and lead to low total testosterone. Hyperthyroidism can also lead to increased conversion of testosterone to estrogen, which presents as gynecomastia or increased breast tissue (Crawford & Kennedy, 2016).
The timing of when the testosterone levels are drawn is also important. You should fast the night before the lab draw and then have your labs drawn between 9 a.m. and 11 a.m. Difficulty sleeping the night before the test can disrupt the diurnal pattern of testosterone production. Men over the age of 60 have less diurnal variation in testosterone secretion (Bremner et al., 1983).
As you can see, evaluating testosterone labs is not as easy as it might seem. Different labs have different standard values for each age group based on their measurement techniques. Simple factors, such as the time of day the lab is drawn, whether you slept well the night before, and your diet, can change your lab values.
If My Testosterone Levels Are Low, Can It Be Harmful To Not Buy TRT Or Testosterone Injections (Whether Online Or Locally)?
In addition to the side effects of low testosterone levels in the body, clinical data has demonstrated a strong link between type 2 diabetes, metabolic syndrome, and low testosterone levels. Testosterone replacement therapy can improve blood sugar control, lipid levels, sexual function, and libido in men with type 2 diabetes with no increase in adverse effects (Jones et al., 2011).
Many men with metabolic syndrome, which is a cluster of conditions that includes increased blood pressure, high blood sugar, excess fat around the waist, and abnormal cholesterol or triglyceride levels, also have low testosterone levels. These men could benefit from TRT to improve their metabolic risk factors. These metabolic factors increase the risk of both stroke and heart disease. Testosterone decreases the incidence of metabolic syndrome with aging and therefore decreases subsequent cardiovascular disease (Ludlow, 2015).
Misconceptions About TRT
Some misconceptions that may lead to a hesitancy to treat men with low testosterone levels with TRT in online clinics or cause men to hesitate to buy testosterone injections online include:
- That TRT contributes to worsening benign prostatic hypertrophy (BPH). BPH is a benign increase in the size of the prostate gland, which leads to urinary retention. A study of 120 men treated with TRT found that TRT was actually associated with a lower risk of urinary tract infections (Pearl et al., 2013)
- That TRT increases the risk of developing prostate cancer. Multiple studies have shown that TRT has not been associated with clinically significant increases in PSA or increased risk of prostate cancer. Significant increases in PSA should not be attributed to TRT and should be investigated (Grober, 2014).
- That TRT increases the risk of cardiovascular events. The results in studies looking at cardiovascular disease and testosterone levels are conflicting. Overall, the study results do not support an association between testosterone use and important cardiovascular events. Further studies are needed (Grober, 2014).
Only about 5 percent of the five million men in the U.S. with low testosterone levels are receiving testosterone replacement therapy. Online TRT clinics and the ability to buy testosterone injections online make treatment more accessible to most men. Most physicians agree that more clinical studies are necessary to evaluate further any relationship between cardiovascular disease and testosterone replacement therapy. Nevertheless, the adverse health effects of low testosterone are well known and in many men, the risk versus benefits analysis favors testosterone supplementation. (Ludlow, 2015).
Dr. Ludlow (2016) cautions that there are many “fly-by-night” places popping up in strip malls. Men need to be careful. Clinics that are not following the standard of care for diagnosis and treatment should be avoided. A combination of low testosterone symptoms and two testosterone values drawn in the morning after fasting overnight that indicate low testosterone levels should be the threshold for diagnosis. A questionnaire such as the Androgen Deficiency in the Aging Male (ADAM) can be helpful in identifying the symptoms of low testosterone levels. Blood tests and symptom questionnaires are helpful, but not perfect. Interpretation by an experienced healthcare professional is essential for an accurate diagnosis.
A thorough history and physical exam are necessary to rule out other contributing diseases and discuss each man’s risk versus benefits profile. Finally, a frank discussion about contraindications to testosterone replacement therapy will ensure that men know the risks if they are not candidates for TRT or testosterone injections and seek to buy them online from a clinic or pharmacy that does not require a prescription.
So, You Want TRT?
Reputable clinics, such as Invigor Medical, that specialize in men’s health are staffed with board-certified physicians who are licensed in your state. These healthcare professionals follow the guidelines of the American Urological Association when diagnosing and treating low-T. You can expect that a comprehensive blood panel will be the first step when you see a physician followed by a thorough medical history and a frank discussion on the risks and benefits of testosterone replacement therapy.
The medical exam and diagnosis are the first step. Buying TRT, such as testosterone injections, online requires a prescription. U.S.-based pharmacies following the rules and regulations for prescribing testosterone require a prescription.
- Ludlow. J. (2015). Is it low testosterone or natural aging? [Video]. Retrieved from https://www.youtube.com/watch?v=kjOAIouaZ0A
- Gruenewald DA, Matsumoto AM. Testosterone supplementation therapy for older men: Potential benefits and risks. J Am Geriatr Soc. 2003;51:101–15. https://pubmed.ncbi.nlm.nih.gov/12534854/
- Basaria S, Dobs AS. Risks versus benefits of testosterone therapy in elderly men. Drugs Aging. 1999;15:131–42. https://pubmed.ncbi.nlm.nih.gov/10495072/
- Bremner WJ, Vitiello MV, Prinz PN. Loss of circadian rhythmicity in blood testosterone levels with aging in normal men. J Clin Endocrinol Metán 1983;56:1278-81. https://pubmed.ncbi.nlm.nih.gov/6841562/
- Crawford, M & Kennedy, L. (2016). Testosterone replacement therapy: role of pituitary and thyroid in diagnosis and treatment. Translational andrology and urology; 5(6). Retrieved from https://tau.amegroups.com/article/view/11917/13166
- Pearl JA, Berhanu D, François N, et al. Testosterone supplementation does not worsen lower urinary tract symptoms. J Urol. 2013;190:1828–33. https://www.auajournals.org/doi/10.1016/j.juro.2013.05.111
- Grober E. D. (2014). Testosterone deficiency and replacement: Myths and realities. Canadian Urological Association journal = Journal de L’Association des urologues du Canada, 8(7-8 Suppl 5), S145–S147. https://doi.org/10.5489/cuaj.2309
- Ludlow, J. (2016). Testosterone: Myths and Facts. [Video]. Retrieved from https://www.youtube.com/watch?v=sM4fNYm0HJs