Yes, it is generally considered safe to be on testosterone replacement therapy (TRT) for life for many individuals and is an effective long-term solution for low testosterone.
Everyone who tried TRT should stay under the close supervision of a healthcare provider and undergo regular monitoring to manage potential side effects and adjust the therapy as needed.
Being on TRT for an extended period, including for life, requires a careful and individualized approach. Testosterone is crucial for maintaining various physiological functions beyond just sexual health, including muscle mass, bone density, mood regulation, and overall energy levels.
For men with clinically low testosterone levels and symptoms of hypogonadism, TRT can significantly improve their quality of life. However, long-term therapy necessitates ongoing evaluation for safety and efficacy.
What Are The Risks Of Long Term TRT?
Long-term use of TRT can increase the risk of cardiovascular issues, such as heart attacks and strokes, and may contribute to the development of polycythemia, prostate enlargement, or exacerbation of pre-existing prostate cancer. It also requires ongoing monitoring for potential side effects, including changes in cholesterol levels, liver function abnormalities, and fertility impacts.
Cardiovascular Risks: There’s been ongoing debate and research about TRT’s impact on heart health. Some studies suggest an increased risk of cardiovascular events, such as heart attacks and strokes, particularly in older men or those with pre-existing heart conditions.
Polycythemia: This is a condition characterized by an increased level of red blood cells, which can increase the risk of thrombosis (blood clots). TRT can elevate hematocrit levels, leading to thicker blood and potentially heightening the risk of clotting and related cardiovascular issues.
Prostate Health: Concerns have been raised about the potential link between TRT and prostate cancer, although the evidence remains inconclusive. TRT can cause growth in prostate tissue, leading to symptoms of benign prostatic hyperplasia (BPH) and potentially complicating the monitoring of prostate cancer.
Sleep Apnea: TRT might exacerbate or contribute to the development of sleep apnea in some men, a condition that can lead to further health complications if not properly managed.
Infertility: Testosterone supplementation can suppress sperm production by reducing the levels of another hormone, gonadotropin, leading to a decrease in testicular size and potentially affecting fertility.
Skin and Hair Changes: Some men may experience acne, oily skin, or male pattern baldness as a result of TRT, due to the hormonal changes it induces.
Mood Fluctuations and Mental Health: While TRT can improve mood in some men, others may experience mood swings, irritability, or changes in mental health.
It’s important to note that the risks of TRT can vary widely depending on the individual, their health status, the dose of testosterone used, and the duration of therapy.
Can You Use TRT For A Short Term?
Yes, TRT can be used for the short term, but it’s typically prescribed for long-term treatment to manage symptoms of testosterone deficiency. Short-term use might not provide the full long-term benefits for conditions like hypogonadism, and stopping treatment could result in the return of symptoms.
When you start TRT, it’s often because the body is not producing sufficient testosterone on its own, leading to various symptoms like reduced libido, fatigue, loss of muscle mass, and mood disturbances.
TRT aims to alleviate these symptoms by restoring testosterone levels to a normal range. Over time, the body becomes accustomed to receiving testosterone from an external source, which can lead to a reduction in the natural production of the hormone by the testes.
This phenomenon occurs due to a negative feedback mechanism where the body reduces its own testosterone production in response to high levels of circulating hormones.
If an individual considers stopping TRT after an extended period, it’s essential to do so under the guidance of a healthcare professional. Abruptly discontinuing TRT can lead to significant symptoms as the body may not immediately resume normal testosterone production, leading to a period of hormone deficiency. Symptoms of low testosterone can re-emerge, potentially affecting quality of life.
A structured approach to discontinuing TRT may involve a gradual tapering of the dose under medical supervision, allowing the body’s natural hormone production mechanisms to reactivate. In some cases, healthcare providers might recommend therapies to stimulate the testes to produce testosterone again.
It’s also important to manage expectations. Depending on the duration of TRT and the underlying reasons for low testosterone, the body’s ability to return to pre-therapy testosterone production levels can vary. In some instances, individuals may find that discontinuing TRT is not feasible due to persistent symptoms of low testosterone.
The decision to stop TRT should be made collaboratively with a healthcare provider, considering factors like the reason for starting TRT, the duration of treatment, overall health status, and individual goals. A carefully planned approach can help mitigate withdrawal symptoms and manage the transition effectively.
Ashlee is the Medical Director at Evolve Wellness and Health in Englewood, Colorado. She obtained her Master of Science in Nursing in 2006 from Colorado State University-Pueblo, and is board-certified through the American Nurses Credentialing Center as an Acute Care Nurse Practitioner. She has practiced in the field of hormone replacement therapy (both male and female) and medical weight loss since 2013.
