The Pitfalls and Perils of Exogenous Testosterone Treatment
Have you noticed the recent surge in late night TV commercials and anti-aging clinics urging men with symptoms of tiredness and low sex drive to seek treatment for a disease that has been newly named … “low T?” The makers of these testosterone replacement therapies tout the clear advantages to male hormone supplementation but few of them warn people of the potential risks to these elective and occasionally unnecessary treatments. Testosterone taken exogenously (via injection, skin patches, gels, creams or oral medications) carries with it some significant and life-changing side effects such as infertility and life-long dependency.
As a physician specializing in male reproductive medicine and male infertility for more than 20 years, I have recently come to see at least a few couples per week in my office who are dealing with the effects of infertility caused by male hormone replacement therapy. They’re frustrated that their physicians didn’t inform them of the potential risks before being prescribed and taking these treatments, especially when the doctor knew they were trying to get pregnant.
It isn’t that the physicians who prescribe male hormone replacement therapies are trying to do harm. Many are simply uninformed of the potential pitfalls associated with these treatments, especially for men who still wish to father children. If you’re considering male hormone replacement therapy, but still want the option to keep your fertility intact, here is what you need to know and talk with your doctor about:
- Testosterone replacements can cause infertility and azoospermia (absence of measurable sperm). Though this condition is reversible in the vast majority of patients, there is still a small group who become permanently impaired.
- Testosterone slows down the glands that work together to produce sperm. The basics of biological science clearly indicate that exogenous hormone replacement therapy has a negative effect on sperm production.
- It can take 2-6 months for sperm production to reach the best levels for conception. Once testosterone replacement therapy is stopped and depending on how long and at what dosage it was taken, it can take months for sperm reserves to rebuild. This delay can be disastrous for women who are at the upper spectrum of their childbearing years.
- Open discussion with your doctor is important. Few physicians know about the fertility side effects that can be caused by male hormone replacement therapies, so they may not bring up family planning in their discussions with you on this topic. Feel free to start the conversation yourself.
- There are other options. Once traditional male hormone replacement therapy is stopped, the rebound to fertility can be speeded along with the use of certain medications. These medications stimulate testosterone and sperm production, thereby allowing men to get the benefits of hormone replacement therapy, without the sterilizing effects.
Today, men in their 40′s and 50′s are beginning hormone replacement therapies in record numbers. But we’re also seeing more men in this age group wanting to father children as well. In my conversations with patients on the topic of male hormone replacement therapy, many don’t realize they are taking an actual drug because it is often delivered as a gel, cream or skin patch. No matter how they are administered, these therapies are most definitely drugs and strong ones at that.
Anyone considering male hormone replacement therapy should be aware of the risks and complications, especially in regards to their fertility. I hope this alert is a small step toward understanding and getting these important conversations started between patients and their primary care providers.
Philip Werthman, M.D.