When is it advisable to start testosterone therapy?

The head of the Urology Service and Coordinator of the Men’s Unit of the Ruber Juan Bravo University Hospital, Francois Peinadohas explained that before starting testosterone therapy (TRT) it is essential confirm that a man has clinical hypogonadismthat is, consistently low blood levels of testosterone accompanied by clear symptoms attributable to deficiency and not to a simple decrease in normal limits.

As men age, it is common for testosterone levels to gradually decrease and symptoms such as lack of energy, decreased libido, mood swings or associated anemia to appear. To alleviate its effects, testosterone therapy It has become one of the most discussed treatments in men’s medicine in recent years.

“However, starting hormonal treatment is not a trivial decision and must be based on solid clinical criteria, both to maximize the benefits and minimize the possible risks,” he indicates. Hairstyle.

Modest effects on erectile function

Current evidence comes from systematic reviews which show that, in men with moderate testosterone deficiency, therapy can improve, above all, sexual desire and energy. “It is important to manage expectations, in the sense that not all the symptoms that a man attributes to low testosterone will respond to therapy,” said the expert.

For example, the TRT It has not demonstrated a clear benefit in improving cognition in men without previous cognitive disorders, it does not prevent the progression of diabetes in people with prediabetes, nor does it improve glycemic control in those who already have established diabetes. Also the effects on erectile function may be modest.

Another aspect to consider, which concerns both doctors and patients, is the safety of TRT. Recent studies have shown that there is no significant increase in the risk of myocardial infarction or stroke in men with preexisting cardiovascular disease treated with testosterone compared with placebo, and there is no strong evidence that TRT increases the risk of prostate cancer.

Side effects

However, the expert warns that it is not free of side effects, since some men may develop erythrocytosis (excessive increase in red blood cells), which can increase the risk of thrombotic events if not adequately monitored. Other potential adverse effects include reduced endogenous testosterone production, low concentration of sperm in the semen (oligospermia) or even no sperm at all (azoospermia).

In these cases there are therapeutic alternatives such as the use of selective modulators of the estrogen receptor (such as clomiphene), which can increase endogenous testosterone production and be especially useful in men who wish to preserve fertility, although this must be evaluated individually with a specialist.

“There is increasing evidence that the decision to start TRT should be made jointly between doctor and patient, based on a complete clinical evaluation, repeated laboratory tests under appropriate conditions (fasting morning levels), and after an honest discussion about expectations, possible benefits and risks in the short and long term,” concludes Peinado.