Pros and Cons of Testosterone replacement

May 31, 2017 3:07 AM

So I got my testosterone tested at a Men's Health place and they said it was both on the low side and that I had significantly low levels of "free testosterone" whatever that is. I've been depressed, low energy, get tired easily and sexually...well not my best. I've read some good things about what this can do for a guy. But on the same token, I've read that when you go off of it, it can play havoc with your metabolism for a while. Even indefinitely. What's the right move here?
posted by anonymous to Health & Fitness (13 answers total)

The right move is to see a medical doctor. What's a 'men's health place?'
posted by fixedgear at 3:27 AM on May 31, 2017

Testosterone replacement gel/patches will rock your life. I've been on it for approx 6 years, no side effects worth mentioning. You'll have more energy, feel better and suddenly get very horney. HOWEVER! at the end of March my insurance co decided that they were't going to pay for it any longer. I could not afford to pay out of pocket, and before I was able to get it re-approved (took forever), I went into what they told me was the equivalent of ladies menopause. I wanted to die, I felt that awful. If you have to stop using it, you must slowly wean off it.

I'm back on it with a patch (used to use a gel). After a week or so I started "over amping" :I was getting too much to fast and we had to adjust dosage, so I use a patch every other day. "over amping" is how I describe it, you can get pissed off at everything, get angry for no reason, feel very anxious etc.

See your doctor, find out what your insurance will pay for. After starting it, keep in close touch with Docs until you adjust.
Good luck.
posted by james33 at 4:56 AM on May 31, 2017

To mangle a metaphor, when you have a warehouse full of hammers, you're going to tell everyone that they have a nail. Your symptoms are real and likely should be treated, but when you go to a clinic that specializes in prescribing testosterone (even if staffed by MDs), you may miss out on other diagnoses and treatments that might be better for you. "... low-T clinics aren't in the business of treating the complex medical problems that often masquerade as low energy and decreased sex drive."

And in case it doesn't go without saying: The first-line treatment for all those symptoms should be sufficient sleep, moderate exercise, and improved diet.
posted by Mr.Know-it-some at 5:24 AM on May 31, 2017

I discussed this with my doc recently, as I am in my 50s. After several tests to establish a baseline he said my levels where normal for my age. But not of course where it was when I was younger. He then told me an interesting story.

He said he had a patient who was in his twenties who came to him to ask about someway to lower his T levels. Seems like the young man just could not help but sleep with anything with a heartbeat. And it was ruining his relationship with his girlfriend. So they took some blood. Turns out his T levels where more what you would see in a man in his 70s or so. In other words, very low. And he continued to test this low.

My doc's point was that there isn't a direct connection between T levels and desire. There can be a whole host of complications as Comrade_robot stated. Which is why I stay away from it.
posted by jtexman1 at 5:48 AM on May 31, 2017

Yeah, like everyone else is saying, go see an MD, and also maybe get a referral for an endocrinologist. A lot of times, the cause of low testosterone is hard to determine, but if you do have something else going on, you need to see if the underlying cause can be treated without hormone replacement. Like, for instance, if you are carrying a bit too much weight in your body, losing weight might help raise your testosterone levels.

My husband tried a topical cream and that was a mess. He switched to injections, but that meant he had to go to the doctor every two weeks. The patch mentioned above was never offered to him, and I think that method of delivery might have appealed to him more. But no matter how it got into his body, he didn't feel much different than he had before he started therapy. And so he just stopped. He experienced the symptoms mentioned above and it was not a fun time for anyone.

Of course, everyone is different. But really, do more research, see a doctor in a doctor's office rather than whatever a men's health clinic is, and get a second opinion if you want to be thorough about your personal health.

Good luck!
posted by danabanana at 5:56 AM on May 31, 2017

If you want to read the science on it, go to scholar.google.com and search for testosterone therapy meta analysis. A meta analysis brings together the results of many small studies, so you're less likely to get the ridiculous headlines that are made out of single small studies whose results are unreliable.
posted by clawsoon at 7:10 AM on May 31, 2017

You need an endocrinologist that's going to carefully monitor your levels and not just sell you more. Too much testosterone gets converted to estrogen. It's amazing and incompetent that they didn't explain what free testosterone is. Lab tests Here's a page directed at trans men, but the biological information applies to you as well.
posted by AFABulous at 7:47 AM on May 31, 2017

IANYD but please, please, please talk to an internist or an endocrinologist. True primary hypotestosteronism is extremely rare. Most men have secondary hypotestosteronism, which is when low testosterone is caused by some other medical problem (often obesity, sleep apnea, but can really be just about any other medical condition). Treating this issue often treats the low T along with it.

Drug companies have aggressively marketed testosterone replacement as they have found new and more expensive delivery methods for it. It makes men feel better but is often felt to be unnecessary, and can come with dangerous side effects.
posted by honeybee413 at 7:59 AM on May 31, 2017

So I got my testosterone tested at a Men's Health place and they said it was both on the low side and that I had significantly low levels of "free testosterone" whatever that is.

I'm going to gently recommend that you learn to distinguish between your actual medical doctors and people whose goal in life is to sell you stuff, or you're going to have an unnecessarily stressful and expensive middle to old age. People who generically refer to themselves as "health" or "wellness" (or both!) people...those people are in the second category.
posted by praemunire at 10:00 AM on May 31, 2017

You can find people opposed to literally everything if you look around enough.

I've been doing injections for 18 months and am very, very happy with the results.
posted by trinity8-director at 11:33 AM on May 31, 2017

Trans guy who used to take Testosterone here: You really, really want to see an Endo about this. They can establish a baseline, prescribe the appropriate amount if warranted, and even work with insurance to get it paid for.
posted by spinifex23 at 2:14 PM on May 31, 2017

Another trans guy here nthing that you really want to see a qualified endocrinologist about this stuff and not a clinic specifically tailored to pushing/selling hormone therapy. The symptoms you describe could be attributed to low testosterone, but could also be attributed to a number of other afflictions. For example, hypothyroidism can result in the symptoms you've described and is extremely common. Additionally, testosterone levels operate within a fairly large range and just because your numbers may be on the 'low' end, doesn't mean you're deficient in any way -- you could just be on the low (but normal) average end. Your free testosterone will always be less (proportionally) than your SHGB testosterone as well. If you're in your 30s, a dip in testosterone is also perfectly normal starting around this time just as a normal part of aging.

With that in mind, I've been taking testosterone for roughly 15 years now and my body relies on it entirely for hormones (as I've had a full hysto and therefore produce little estrogen). When I miss a couple of doses it is extremely noticeable -- not only in my testosterone levels, but in other areas as well (such as liver enzymes, blood panels, ect). If your testosterone levels are as low as the Men's Health clinic is making you fear -- I would highly recommend getting additional bloodwork done.

That said, it's been incredibly concerning for me to see this sudden push/advertising for testosterone geared towards cismen in the past few years that promises testosterone will cure all their woes -- particularly sexual function. It's incredibly misleading and downplays the dangers associated with hormone therapy (especially if you don't really need it). These dangers are often glossed over and why a qualified endo is necessary so as to help understand if supplemental testosterone would be worth the risks (or if it's needed at all).
posted by stubbehtail at 12:42 AM on June 1, 2017

40-ish white male here. A few years ago some blood work showed lower-than-would-be-expected bio-available testosterone. Endocrinologist put me on clomiphene citrate - problem solved. YMMV. Honestly I think dropping 20 lbs solved 75% of the problems.
posted by Farce_First at 2:57 PM on June 1, 2017