The Long-Term Effects Of TRT - Dr Peter Attia

Summary

This discussion delves into the rising use of testosterone replacement therapy (TRT) among young men, exploring both its benefits and risks. While TRT can be an effective treatment for low testosterone, concerns arise when used improperly or at super-physiologic doses, especially in younger individuals. Risks include fertility loss, cardiovascular complications, and potential long-term health effects, such as increased blood viscosity and hormonal imbalances. Experts emphasize the importance of proper medical guidance and monitoring, stressing that while TRT is safe when done correctly, its misuse—often in pursuit of performance enhancement—can lead to serious health consequences.

Takeaways

• 😀 TRT usage is on the rise among young men, often to boost mood or physical performance, but it carries risks when misused.
• 😀 Testosterone replacement therapy (TRT) can be safe when done correctly, especially at appropriate, physiologic doses under medical supervision.
• 😀 The main risks associated with TRT at physiologic doses include potential impacts on prostate cancer and cardiovascular health, but recent studies suggest these risks may be lower than previously thought.
• 😀 There is no evidence that TRT initiates prostate cancer in men, and in fact, it may even reduce the risk slightly, particularly post-prostatectomy.
• 😀 The cardiovascular risks associated with TRT are still being debated, with some studies showing no increase in heart disease risk, though higher doses may be more concerning.
• 😀 Super-physiologic doses of testosterone, common in some TRT clinics, can lead to serious side effects such as blood thickening, increased red blood cell production, and potentially higher cardiovascular risks.
• 😀 Men using excessive doses of testosterone may also develop issues like gynecomastia (enlarged breast tissue) and hair loss, requiring additional medications like aromatase inhibitors or finasteride.
• 😀 Long-term use of finasteride (a drug used to prevent hair loss) can cause permanent loss of libido in some men, a condition known as post-finasteride syndrome.
• 😀 Fertility can be significantly impacted by exogenous testosterone, especially in younger men. Extended TRT use can suppress sperm production, potentially leading to permanent infertility.
• 😀 Alternative treatments like Clomid (used to boost endogenous testosterone) can have long-term side effects, including an increased risk of cardiovascular disease and cataracts if used over extended periods.
• 😀 While TRT can be beneficial for some men, particularly those with medically indicated low testosterone, younger men should be cautious due to the long-term impact on fertility and overall health.

Q & A

What is the primary concern regarding the rise in TRT usage among young men?

The primary concern is that many young men may not fully understand the risks associated with TRT, such as its impact on fertility, cardiovascular health, and potential misuse through unregulated clinics.

How does testosterone replacement therapy (TRT) affect prostate cancer risk?

Studies have shown that TRT does not increase the risk of prostate cancer and may even decrease the risk in some cases. In fact, men who have had prostate cancer and undergone prostatectomy are still prescribed TRT if warranted.

What cardiovascular risks are associated with TRT, and what does the data suggest?

The data on cardiovascular risks associated with TRT is inconclusive. Some studies, such as the Traverse trial, show no increase in cardiovascular disease risk with TRT. However, concerns remain about the effects of low doses of testosterone in real-world clinical settings.

What are the potential risks when TRT is administered at super-physiologic doses?

Super-physiologic doses of TRT can lead to increased red blood cell production, higher blood viscosity, and a risk of polycythemia vera, a condition where red blood cell production becomes uncontrollable.

How can TRT affect fertility, especially in young men?

TRT can significantly reduce sperm production, leading to infertility. Young men who use TRT may face permanent infertility after extended use, with the effects becoming more difficult to reverse after two years of exogenous testosterone use.

What are some of the additional drugs used to mitigate side effects of TRT, and why are they concerning?

Some men take aromatase inhibitors and finasteride to counteract side effects like gynecomastia and hair loss. However, these drugs can introduce new risks, including permanent loss of libido and potential irreversible side effects.

Why is Clomid used in TRT, and what are the risks of long-term use?

Clomid is used to preserve fertility by stimulating the body's production of testosterone. However, long-term use can raise concerns about an increased risk of atherosclerosis, cataracts, and other health complications due to elevated levels of a substance called desol.

What are the concerns with illegal or unregulated TRT treatments?

When TRT is obtained illegally or from unregulated clinics, there are additional risks, including contamination of the substances, improper dosing, and a lack of proper medical supervision, which can lead to significant health complications.

How does TRT affect estrogen and DHT levels, and what are the consequences?

Super-physiologic TRT doses can elevate estrogen and DHT levels, leading to side effects like gynecomastia (enlarged breast tissue) and hair loss. To manage these effects, some men use medications like finasteride and aromatase inhibitors, which can come with their own risks.

Is it safe for men to remain on TRT indefinitely?

TRT can be safe for men when administered at physiologic doses and under proper medical supervision. However, young men who start TRT may face long-term risks such as fertility issues, and the therapy should be carefully monitored to mitigate potential health complications.