From the Guidelines
Testosterone replacement therapy (TRT) may provide small improvements in sexual functioning and quality of life in older men with low testosterone levels without well-established medical conditions known to cause hypogonadism. According to a 2020 study published in the Annals of Internal Medicine 1, TRT has been shown to have benefits in certain aspects of health, although long-term efficacy and safety are unknown. The study found that testosterone therapy may provide small improvements in sexual functioning and quality of life, but little to no benefit for other common symptoms of aging.
Key Benefits of TRT
- Improves sexual functioning
- Enhances quality of life
- May have benefits for men with documented testosterone deficiency, although the study did not specifically address this population
Important Considerations
- Long-term efficacy and safety of TRT are unknown
- Testosterone treatment is approved by the U.S. Food and Drug Administration (FDA) for replacement therapy for men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes
- Substantial proportions of U.S. men who receive testosterone therapy do not have testosterone levels tested before initiation of therapy, highlighting the need for proper monitoring and diagnosis
Proper Monitoring and Diagnosis
- Regular blood tests checking testosterone levels, hematocrit, PSA, and lipid profiles are essential for proper monitoring
- Diagnosis and evaluation of hypogonadism should be conducted according to established guidelines, such as those from the Endocrine Society 1
From the Research
Benefits of Testosterone Replacement Therapy (TRT)
- Improved body composition and sexual function, as evidenced by strong and consistent data 2
- Moderately consistent evidence for improved bone mineral density 2
- Potential benefits for mood and cognitive function, although evidence is weak and inconsistent 2
- Improved muscle mass and strength, and decreased body fat, particularly abdominal fat 2
- Positive influence on bone mass, skeletal muscle, and adipose tissue distribution 3
Debunking Old Myths
- The concern that TRT may stimulate prostate cancer is not supported by decades of data accumulated to date 2
- A study of 12,779 men with late-onset hypogonadism found no association between TRT and an increased risk of prostate cancer 4
- TRT is not associated with an overall increased risk of prostate cancer, with a hazard ratio of 0.97 (95% confidence interval: 0.71,1.32) compared to nonuse 4
Forms of TRT and Their Benefits
- Transcutaneous (gel) testosterone and long-acting injectable formulations can keep serum testosterone levels in the physiological range, imitating its circadian rhythm 3
- Long-acting injectable undecanoate testosterone can improve patient compliance, as requested for a life-long treatment 3
- Various testosterone formulations are available, including buccal, nasal, subdermal, transdermal, and intramuscular (IM) routes of delivery 5
Important Considerations
- Patients receiving TRT require close monitoring, and management discussions should be individualized to address patient needs and goals 6
- Counseling before therapy should include shared decision-making regarding risks, benefits, and expectations 6
- Clinicians must consider the unique characteristics of each patient and make necessary adjustments in the management of late-onset hypogonadism to provide the safest and most beneficial results 5