\n<\/p>\n
This episode was made possible by the support of Yakult and produced independently by Scientific American\u2019s board of editors.<\/p>\n
Rachel Feltman: For Scientific American\u2019s Science Quickly, I\u2019m Rachel Feltman.<\/p>\n
Whether it\u2019s framed as a cure-all for fatigue and low libido or a shortcut to gaining muscle mass, testosterone replacement therapy, or TRT, is all over the Internet these days. But how much of the hype is actually backed by science?<\/p>\n
If you’re enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.<\/p>\n
Here to help us make sense of the testosterone boom is Stephanie Pappas, a freelance reporter based in Colorado. Stephanie recently covered the growing popularity\u2014and availability\u2014of TRT for Scientific American.<\/p>\n
Thanks so much for coming on to chat.<\/p>\n
Stephanie Pappas: Thank you.<\/p>\n
Feltman: So you recently wrote about testosterone replacement therapy for Scientific American. For folks who are not on the right part of the Internet to have heard all about this\u2014or maybe staying off the wrong parts [laughs] of the Internet, depending on your perspective\u2014what\u2019s going on with TRT right now?<\/p>\n
Pappas: Well, testosterone replacement therapy has become extremely popular. It has been something that\u2019s been in the background for many, many years. Synthetic testosterone was first invented in 1935, but for a long, long time people thought that testosterone replacement, if it was used for any kind of symptoms men might be having, that it could cause prostate cancer. And then it was believed, perhaps, it could cause heart disease or cardiovascular events like a stroke or a heart attack.<\/p>\n
As it turns out the last few years we found that it doesn\u2019t really cause these really serious events. However, a lot less is known about the long-term health impacts. People are really flocking to TRT largely as a result of word of mouth. There are a lot of private clinics that offer this out of pocket, so you don\u2019t have to have an insurance company agree that you need it. And people on social media are using it for just a litany of different symptoms, and it can be anything from muscle-building to fatigue to mood problems and irritability, and it\u2019s kind of being pitched as a cure-all for a lot of different things.<\/p>\n
Feltman: And what evidence is there for the benefits of testosterone replacement therapy, maybe starting with people who actually have low testosterone?<\/p>\n
Pappas: Yeah, so there is such a thing as low testosterone. No one exactly agrees on what the cutoff is, and probably that\u2019s because there\u2019s a lot of variability in our hormones\u2014like, anyone who\u2019s ever tried any sort of hormone treatment, including birth control or HRT [hormone replacement therapy], can tell you that people respond really differently.<\/p>\n
So for men who really do have low testosterone, the evidence suggests that you can see some benefits in mood if you have major depression. You may see some improvements in energy. The most well-established result from the studies of TRT is that you\u2019ll probably see a little boost in libido if you have low testosterone and you now start taking TRT, and that\u2019s because testosterone works in the brain to increase sexual desire.<\/p>\n
Feltman: Hmm.<\/p>\n
Pappas: For men who don\u2019t have low testosterone, which are many of the men who are now getting treatment, the evidence for benefits is much, much lower. We don\u2019t know if you really see much besides additional muscle-building abilities.<\/p>\n
Feltman: And what are the potential downsides? You mentioned that one of the reasons there\u2019s such a boom right now is that research has showed that the connection to prostate cancer is not concerning the way we once thought it was. But what about other issues that can come up when you don\u2019t have low testosterone and you start taking a bunch of testosterone?<\/p>\n
Pappas: Right, so if you are taking a testosterone supplement, your body actually shuts down its own testosterone production. There\u2019s this neat little feedback loop that says, \u201cOh, if the testosterone\u2019s high in the blood, we\u2019re going to just kind of ramp it down.\u201d And a side effect of that is, actually, because testosterone is involved in sperm production, your body will also stop producing sperm. So as more younger men turn to TRT, we are seeing that men who are interested in still having children are finding they\u2019re losing their fertility. Oftentimes men are told, \u201cOh, you\u2019ll recover it once you stop.\u201d But that can actually be slow and complicated, so urologists in the field often see men who aren\u2019t understanding why they\u2019re not, you know, able to get their partner pregnant, and they may have tried for quite some time.<\/p>\n
Feltman: Right, and, you know, not that this is the reason that\u2019s upsetting, but there is also kind of an irony there because a lot of the marketing is sort of stereotypical masculinity, so it\u2019s not surprising that people are caught off guard by that potential downside.<\/p>\n
Pappas: Yes, absolutely. They are really marketing this\u2014if you go, you can see it on billboards or online\u2014these ads are all about muscles, they\u2019re about machoism. And oftentimes the reports from some of these freestanding clinics is that men are not being told all the information about all the side-effect possibilities.<\/p>\n
Feltman: When you say that regaining fertility after these treatments can be complex and slow, could you walk us through what you mean by that?<\/p>\n
Pappas: Sure, because your own testosterone levels and sperm production drop, you\u2019re going to have to, usually, get off the testosterone. That can really lead to a hormone crash; since your body is, really, at that point in quite low testosterone, you may feel irritable, you may feel fatigue. So you\u2019re gonna have to go through that\u2014a bit of a roller coaster.<\/p>\n
Doctors will prescribe some medications that can help even out your levels and help encourage your body to start producing its own sperm again. That can take some time; it can be a little expensive. Urologists can help you, though. But they do say that they are concerned that men have a, often, too rosy picture of what that\u2019s gonna look like. It can take up to two years to recover full fertility, there\u2019s kind of an unknown as to whether sperm quality will be quite as high as it was beforehand. And as anyone who\u2019s trying to have kids knows, two years can be quite a while when you\u2019re dealing with fertility problems.<\/p>\n
Feltman: Yeah, so let\u2019s talk some more about those freestanding clinics. You know, in addition to TRT, you know, being more in demand and more in the conversation, it also seems like it\u2019s more accessible than ever, so what are some of the sort of concerning characteristics of these clinics that are popping up?<\/p>\n
Pappas: Well, you don\u2019t wanna paint all clinics with the same brush …<\/p>\n
Feltman: Sure.<\/p>\n
Pappas: Because there is a wide variety of care out there. So it can be any provider that can prescribe\u2014because testosterone is a controlled substance\u2014but they may not really be running you through a full workup, as a urologist or an endocrinologist affiliated with a practice or a hospital system might do.<\/p>\n
The recommendations from professional societies suggest you get two testosterone tests on different days because testosterone levels swing wildly. I could not find anyone who\u2019d reported to me that they\u2019d gotten two tests. I can\u2019t say that there aren\u2019t clinics that do it. Typically you\u2019re gonna get one test. Typically they are motivated to prescribe what they can to you.<\/p>\n
The problem, often, is that because of this long-term fear around testosterone, is that many primary care doctors are nervous about prescribing it or don\u2019t feel that they\u2019ve been trained. I spoke to one man who, actually, his doctor said, \u201cYes, your testosterone is undeniably low, but I don\u2019t know what to do about it. Maybe just go to one of these clinics, and they can help you.\u201d<\/p>\n
His experience in that clinic, unfortunately, was that they kind of gave him a generic prescription, did not really test through his levels, didn\u2019t really talk through, you know, alternative treatments or other things he might look at doing. So he felt his loss and he ended up looking on Reddit for advice, which, as we all know [laughs], is a real hit-and-miss proposition …<\/p>\n
Feltman: Sure.<\/p>\n
Pappas: So men are often kind of left searching for their own information, and they may not have good sources of information.<\/p>\n
Feltman: And the experts that you spoke to, what do they wanna see change about the way we\u2019re treating TRT?<\/p>\n
Pappas: The first step is that a lot of physicians who specialize in hormone replacement therapy for men would like to see more awareness among primary care physicians and other doctors that men might go to, because if they could coordinate that care in a really responsible way, there are probably many men who could benefit: they do have low testosterone but haven\u2019t ever thought about being tested.<\/p>\n
And then the other side of this is just patient education. If you\u2019re going to consider going to a clinic, don\u2019t just go somewhere that will happily hand you a prescription. Really look for someone who is going to sit down with you, who is going to talk through lifestyle changes, who\u2019s going to look at alternative problems. So one doctor I spoke to said, \u201cThe first thing we do is we look for sleep apnea in our patients. If we can cure that, oftentimes we don\u2019t need to look at their testosterone levels again.\u201d<\/p>\n
And don\u2019t be in a rush to walk out that first day with a prescription that might be too high for you and might lead to side effects like acne, or another side effect you can see is an overgrowth of red blood cells that can lead you to need to have to donate blood every month to keep that in normal range. Look for something that\u2019s not going to cause the side effects that can really affect your life in the long term.<\/p>\n
Feltman: Sure, well, thank you so much for coming on to talk us through your feature. I really appreciate it.<\/p>\n
Pappas: Thank you so much.<\/p>\n
Feltman: That\u2019s all for today\u2019s episode. You can read Stephanie\u2019s full story on TRT in the July\/August issue of Scientific American.<\/p>\n
We\u2019ll be back next week with something special: a three-part miniseries on bird flu. From avian influenza\u2019s wild origins to its spread across U.S. farms to the labs trying to keep it from becoming the next pandemic, this looming public health threat has a lot of moving parts, but we\u2019ll get you all caught up.<\/p>\n
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi, Kelso Harper, Naeem Amarsy and Jeff DelViscio. This episode was edited by Alex Sugiura. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.<\/p>\n
For Scientific American, this is Rachel Feltman. Have a great weekend!<\/p>\n","protected":false},"excerpt":{"rendered":"
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