Is it Safe? And Five Common Questions on Testosterone Replacement Therapy (TRT) at ABQ Today

Testosterone therapy sales skyrocketed over the past two decades. It is most likely because the aging population has become increasingly aware of the benefits and risks of testosterone replacement therapy, among others. 

It's amazing why testosterone pellets have gained so much popularity nowadays. One main reason is the availability of prescription testosterone in various forms. But questions about its safety and efficacy continue to hinder several aging men and women from enjoying its benefits.

With both men and women seeking out testosterone replacement for specific needs, let’s tackle a few questions related to understanding this treatment better.

Getting to Know – Testosterone.

Testosterone is a very significant hormone, not just for aging couples but for the general population as well. It can boost libido, energy, muscle, and mood, sharpen memory, and encourage fat loss. 

While studies show that testosterone is popular among aging men for such reasons, testosterone therapy can also benefit women. It specifically has a role in postmenopausal women with a hypoactive sexual disorder, but more than that, testosterone therapy also encourages the following for women:

• Aid in the maintenance and healthy development of bone tissue.
• Help boost and sustain muscle mass.
• Weight loss through decreasing the amount of fat stored in the body, especially in post-menopausal women.
• Encourage a healthy sex drive.
• Reduce the risk for vaginal atrophy in post-menopausal women.

Testosterone levels decrease with age. And while testosterone therapy has a few drawbacks, the benefits are still likely to outweigh the risks. Add to that, continuous studies and innovations provided options so everyone can avoid these so-called drawbacks. 

The success of hormone replacement therapy centers on the idea of getting the right dose and having it through the right delivery method. Testosterone therapy comes in many forms, but the novel idea of having testosterone replacement therapy through hormone pellets is revolutionary.

Let’s clear the fog on a few questions that are frequently encountered when considering testosterone replacement therapy.

1. Testosterone is a male hormone. Does it masculinize females?

Testosterone has been long referred to by scientific publications as the “male hormone”. 

However, while men have higher circulating levels of testosterone compared to women, the most abundant active sex steroid in women is actually – yes, you guessed it right – testosterone! 

And not just that, this happens all throughout the female lifespan, even beyond menopause! 

Testosterone decline is more noticeable in females because of the symptoms. Androgen levels decline as a person ages, which is why both aging men and women experience the following:

• anxiety
• irritability
• depression
• generalized lack of well-being
• physical fatigue
• bone and muscle loss
• memory changes
• insomnia
• hot flashes
• breast pain
• urinary complaints
• incontinence
• sexual dysfunction.

Testosterone is crucial for a woman's physical and mental health, as well as overall well-being. Therefore supplementation with testosterone in women has become a very good health support as it helps with the overall quality of life. 
But does it masculinize females? Unwanted side effects are easily reversible upon lowering testosterone doses. Studies have shown that the masculinization of a female fetus may require extremely high doses of testosterone administered over a long period. When given within the right dose limits, it does not masculinize women.

2. Does testosterone therapy cause liver damage?

Orally administered testosterone is highly metabolized in the liver. Thus, high doses of oral testosterone could cause adverse effects on the liver. This is still rare though, as there are only three recorded reports of liver cancer in men treated with high doses of oral synthetic methyl testosterone.

This is the advantage of having non-oral testosterone therapy. It avoids enterohepatic circulation and therefore does not affect the liver, liver enzymes, and clotting factors

3. Is testosterone therapy bad for the heart?

Contrary to assumptions that testosterone is bad for the heart, it is in fact, cardioprotective. 

Testosterone is beneficial in terms of glucose metabolism and lipid profiles among both men and women. It was even used to manage cardiovascular disease and diabetes. 

Multiple studies have shown that testosterone acts as a vasodilator and can prevent atherosclerosis. It, therefore, is advantageous for the overall function of cardiac muscle.  

On the contrary, low testosterone levels in men are linked to a greater risk of heart disease, reduced exercise capacity, and poor health outcomes in patients who have heart failure. Supplementation with testosterone has been shown to enhance functional capacity, decrease insulin resistance, and increase muscle strength in women with congestive heart failure.

4. Does testosterone therapy cause hoarseness and voice changes?

There are currently no reports linking testosterone therapy to hoarseness and voice changes. As a matter of fact, hoarseness is most commonly caused by inflammatory changes, and yes, also noted as a symptom of testosterone deficiency.

There are some old reports linking testosterone therapy to voice changes. However, a study conducted way back 2016 regarding the effect of testosterone implants on the female voice concluded that no vocal changes are attributed to the ongoing hormone replacement therapy.

5. Does testosterone therapy increase the risk of breast cancer?

This is a rather controversial question as it involves the big C! It should be clarified that testosterone therapy is also breast protective and does not predispose to breast cancer. 

Clinical trials have established that testosterone is beneficial to breast tissue because it decreases breast tissue production and prevents stimulation from estrogen. The balance between testosterone and estrogen gives protection. 

As a matter of fact, research over the years has many times cemented the fact that testosterone therapy does not cause breast cancer. 

An old retrospective observational study done in 2004 on 508 post-menopausal women receiving testosterone on top of usual hormonal therapy supports the claim. Results showed that the addition of testosterone did not increase (and has even reduced) breast cancer risk associated with hormone therapy.

This is reinforced by recent studies. A newer study in 2019 that followed 1267 women given testosterone pellets over a ten-year study period noted a 39% lower incidence of breast cancer among its participants. Testosterone combined with a component called an aromatase inhibitor was further shown to help effectively manage androgen deficiency symptoms in breast cancer survivors. 

Another study was conducted in 2021 on testosterone pellets as a form of subcutaneous hormone pellet therapy on pre and post-menopausal women. Results revealed a 35.5% reduction in invasive breast cancer incidence. 

Testosterone pellets should be further investigated for its potential and benefits in terms of hormone therapy, breast cancer prevention, and cancer therapy in general.

The most important question: is it safe?

While many claim that testosterone therapy on women is not yet deemed safe, long-term data suggests otherwise. This data spans across approximately 40 years of clinical studies, and established the safety and efficacy of doses of up to 225 mg. 

Continuous long-term follow-up studies on very high doses used on ‘female to male’ transgender patients also report no increase in terms of mortality, breast cancer, vascular disease, or other major health problems.

Many of the adverse effects and safety concerns attributed to testosterone replacement therapy are from oral formulations. These adverse effects are best prevented through going for testosterone therapy that does not involve the gastrointestinal tract. 

These effects are also most likely due to so-called increased aromatase activity. Aromatase is an enzyme or refers to a group of enzymes that encourage the conversion of androgen into estrogen.

Aromatase activity is noted to increase with age, obesity, alcohol intake, insulin resistance, and breast cancer. It is also noted to increase in relation with drug usage, processed diet, and sedentary lifestyle.

To guarantee the safe administration of testosterone therapy especially in the form of hormone pellets, always have it performed and administered in a clinic you can trust. Monitoring of aromatase activity and symptoms of elevated estradiol is crucial to the safe use of testosterone in both men and women. 

Thus, it is important to emphasize that hormone replacement therapy should be done at a clinic where the clinician’s skills and knowledge are unquestionable. A clinic that offers diagnostics that can assist in monitoring hormone replacement response levels is a plus.