The Testosterone Dilemma

Sep 1, 2014


Like any medical treatment, the decision to use testosterone replacement therapy must be based on individual factors, and a frank conversation with one’s doctor. Experts continue to debate the long-term risks and benefits of testosterone replacement therapy (TRT). Unfortunately, there are no universal guidelines for the diagnosis or treatment of men found to have low testosterone. Many experts still disagree about exactly what values define “low” testosterone.

What is a man to do when confronted with this complex dilemma?

It is increasingly obvious that the “business” of TRT is a major driving force within the medical community.  Sales of prescription testosterone gel products alone generated well over $2 billion within the U.S. last year alone. This is expected to continue to rise steadily as the direct to consumer marketing by pharmaceutical companies expands to well over $3 billion.

Men should be encouraged to seek reliable and factual advice grounded in the latest scientific research regarding this debate. Urologists are trained in all aspects of male sexual health, and we are uniquely qualified to guide our patients through this increasingly complex discussion. Most endocrinologists are also quite interested in and well versed in all aspects of TRT.

In our practice, we have been recently confronted with many patients receiving poor and improper advice from clinics that simply know to prescribe medications for patients without giving the adequate advice and guidance needed to make an informed decision.

I have written extensively about this topic, but I believe it is increasingly important to share this information with our patients — repeatedly. For example, men interested in fathering children should NOT be offered traditional TRT. This is a common mistake from most ‘clinics’ that simply sell testosterone as if it were an elixir for a variety of ailments. Once testosterone is given through any form (topical or injection) the testicles begin to simply hibernate and their function declines. Function may or may not return and we as clinicians are unable to determine the long term chances for the resumption of sperm production once TRT is initiated. There are however common therapies employed by trained urologists and endocrinologists that can not only raise the level of testosterone but, equally as important, have no long term negative impact on future fertility.

Fortunately, there is a Princeton Consensus Conference scheduled for later this year. The conference is expected to review all the recent clinical studies and data in an objective and clear way. We expect this will give men and their physicians further guidance and clarification as we continue this important debate. I believe it will continue to be clear however, that important decisions about TRT must be made by trusted physicians with particular skills and training in this complex topic.