Testosterone levels naturally decline with age in men, leading some to seek testosterone replacement therapy (TRT). However, TRT is surrounded by many myths and misconceptions. In this blog, we’ll separate the myths from the facts about TRT.
Myth #1: TRT Causes Prostate Cancer
One common myth is that TRT increases the risk of prostate cancer. However, research to date has not found clear evidence that TRT increases prostate cancer risk. A 2021 study followed over 1,500 men receiving TRT for up to 20 years and found their prostate cancer risk was not elevated compared to the general population. More research is still needed, but the current evidence does not support this myth.
Myth #2: TRT Shrinks Testicles
Another myth holds that supplementing with testosterone will cause the testes to stop producing it naturally and shrink. In reality, most men maintain natural testosterone production with TRT along with testicular size and function. One study saw no difference in testicular volume after 2 years on TRT. Temporary testicle shrinkage can occur in men who had already had low testosterone levels prior to TRT. Overall, there’s little evidence for permanent testicular changes.
Myth #3: TRT Causes Blood Clots
The belief that TRT heightens blood clot risk is another misunderstanding. While past synthetic steroids carried this risk, today’s bioidentical testosterone does not appear to increase clotting factors or platelet counts. Men over 45 naturally have higher clot risk due to aging and lifestyle factors. Younger men may want to avoid TRT if they have other individual blood clot risk factors, but TRT itself does not heighten the risk.
Myth #4: TRT Worsens Sleep Apnea
Many think supplemental testosterone aggravates sleep apnea. Again, studies do not back up this myth with evidence. While testosterone fluctuations can influence breathing during sleep, TRT has not been found to worsen pre-existing sleep apnea. However, the dose response is unclear, so men starting TRT with untreated sleep apnea should monitor for any effects. Overall, TRT appears neutral on sleep apnea for most men.
The Reality: Benefits vs. Risk Analysis Needed
Testosterone therapy clearly helps many men experiencing low testosterone (low-T) symptoms. Benefits like increased energy, sexual function, mood, motivation and vitality have been consistently demonstrated. However, as with any treatment, men should weigh those benefits against the potential risks and work closely with their doctor to manage those risks. Monitoring testosterone levels, prostate health, cardiovascular markers, blood counts and other factors can help ensure safe long-term treatment.
The decision about TRT includes both medical considerations as well as discussion of the man’s preferences and desired lifestyle outcomes. Having realistic expectations about results can help men determine if benefits are worth the risks and commitment to treatment. Finding a knowledgeable doctor to have thorough and unbiased discussions with is key for each individual making this personal decision.
While myths still exist and more research is always emerging, today’s evidence paints a clearer picture about testosterone therapy. Separating fact from fiction can empower men to make the choice that’s right for their values, priorities and quality of life as they age.
