[marianco]

Originally Posted by Zek

That is my biggest concern. I want to have children one day and I don't want TRT to cause a problem with that.

Testosterone replacement therapy (TRT) entails increasing DEFICIENT levels of testosterone to NORMAL or OPTIMAL PHYSIOLOGIC levels per that particular person. A person should be deficient in testosterone in the first place to receive TRT.

Some adverse effects and associated conditions:

1. If only testosterone is used in replacement therapy, a person does run the risk of causing atrophy of the testes and reduction in sperm production. This is because with the higher testosterone levels, the brain does not need to produce luteinizing hormone (LH) and follicle stimulating hormone (FSH) to increase testosterone production. The lower follicle stimulating hormone levels also reduce sperm production. If a person wants to have optimum fertility, while on testosterone replacement therapy, then it is important to supplement testosterone treatment with human chorionic gonadotropin (HCG) treatment. HCG behaves in the human body like LH and FSH. It will keep the testes from atrophy, and maintain sperm production. SWALE has a great protocol to use as a starting point.

2. It is important to monitor for prostate cancer. Testosterone itself does not cause prostate cancer - estrogen is much more of a risk for prostate cancer. However, testosterone, like estrogen, promotes tissue growth. Thus, testosterone needs to be blocked or withdrawn if prostate cancer exists. Some recommend twice a year prostate exams and more frequent prostate specific antigen tests when on testosterone replacement therapy to monitor for prostate cancer.

3. If dihydrotestosterone (DHT) levels become too high (from conversion from testosterone via the alpha-reductase enzyme), then hair loss may accellerate. Excessively high DHT levels may also increase visceral (belly) fat - which then increases the risk of high cholesterol, blood pressure, stroke and heart attacks, cancer, etc. DHT levels are easily monitored via blood tests. An easy way to monitor DHT levels informally is to see if one gets acne - a symptom of perhaps excessive DHT levels. When DHT is increased, one may also notice more body hair or faster hair growth in the DHT-resistant hair follicles (the ones that one does not easily lose when going bald). I, myself, try to aim for testosterone levels between the age of 24-30, not teenage male levels.

4. If estrogen levels become too high (from conversion from testosterone via the aromatase enzyme), then you have a higher risk for weight gain, heart attack, stroke, cancer, etc. A sign of excess estrogens is gynecomastia (breast growth) in men. Estrogen levels are easily monitored and can be treated.

5. If, a person has been deficient in testosterone for a long time, eventually, adrenal fatigue can set in. This means the adrenal glands cannot make enough Cortisol and other hormones when needed to help the mind and body withstand stress. An initial problem with elevating testosterone is that one of testosterone's functions is to suppress the spike in cortisol and other hormones from the adrenal glands. This helps limit the stress response - preventing damage to the body from excessive cortisol and other hormone levels (this includes diabetes, obesity, muscle wasting, etc.). The initial testosterone elevation suppresses cortisol temporarily (until the adrenals can recover from their fatigue from the calming/stress-reducing effects of testosterone). This temporary suppression of cortisol may make a person more susceptible to viral illnesses such as colds. This is not often seen as a problem in people, but is possible, and should be expected to be transient. It is an example of secondary problems that can occur from deficient testosterone levels.

6. Prostatic enlargement (and urinary retention and urinary frequency) from higher DHT and higher Estrogen levels is a possibility with testosterone replacement. Treatment may include taking saw palmetto (which seems to be highly specific for blocking prostate alpha-reductase rather than systemic alpha-reductase - and is thus safer to use than finesteride and other commercial alpha-reductase inhibitors with TRT), and taking arimidex (or other aromatase inhibitor), or taking DIM (to reduce estrogen activity). Testosterone, itself (rather than DHT), over time may reduce prostatic enlargement.

7. Higher red blood cell counts may occur as testosterone levels are increased. This thickens the blood, and if in excess may increase the risk of developing a blood clot. It may also make it more difficult for a person to breath - particularly an elderly person with a lung and cardiovascular system disease. It is important to keep this in mind and check the blood count. One of testosterone's functions is to stimulate the creation of red blood cells - highly useful, but not in excess.

When increasing the testosterone levels, it is important to be aware of other neurotransmitter/hormones that are effected and to be aware if adverse effects can occur, then to take steps to counter those adverse effects.

Most of these adverse effect occur from secondary imbalances in other neurotransmitters and hormones. The watchword is maintaining "balance" - maintaining physiologic levels of all the neurotransmitters and hormones - which minimizes risk and optimizes function. In general, I think when physiologic levels of testosterone and other neurotransmitters and hormones are maintained, the risk of adverse effects is very low with testosterone replacement therapy. Of course, if a person accomplishes testosterone replacement therapy using drugs such as aromatase inhibitors (e.g. arimidex), then the person runs the risk of adverse effects of each individual drug itself.

For each person, it is important to weigh the risks and benefits of treatment. However, the risks of continuing deficient testosterone levels are clear. They include:
1. Heart attacks.
2. Strokes.
3. Prostate cancer, possibly other cancers (from unbalanced estrogens actions).
4. Chronic fatigue and difficulty coping with stress (accompanying adrenal fatigue/insufficiency that secondarily occurs with low testosterone levels)
5. Excessive anxiety, stress, irritability, anger outbursts (the irritable male syndrome)
6. Severe depression.
7. Impaired memory and attention, difficulty learning new material (some to the extent of a dementia-like syndrome).
8. Impaired fertility - if low FSH/LH levels or FSH/LH resistance are the cause of low testosterone levels.
9. Lack of libido, erectile dysfunction - often bandaged with Viagra, but with undiagnosed testosterone deficiency as a direct cause.
10. Obesity - which is difficult to treat with diet alone - which can lead to arthritic conditions.
11. Diabetes
12. Loss of muscle mass.
13. Osteoporosis
14. Impaired immune system.
15. Reduced reaction time, quickness of reaction, mental quickness (from reduced dopamine levels, insulin-resistance associated with testosterone deficiency - among other associated changes)

There is a general progresson of other heretofore "age-associated" changes in one's health and ability to function - which would have been prevented by maintaining optimum testosterone levels.

Ultimately, maintaining testosterone deficiency may significantly reduce the quality of one's life.