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What are the risks of testosterone replacement therapy?

Posted at 5:29 PM, Jan 18, 2023

Advertisements for testosterone therapy are all over the internet. However, new research suggests customers aren't always told about the risks when getting supplements from websites.

Urologists and men’s health specialists who see patients daily wanted to see if websites followed the same guidelines when prescribing testosterone.

Dr. Justin Dubin played the role of an online shopper interested in testosterone therapy. He presented himself as a 34-year-old man with low libido and low energy. Dubin filled out the required paperwork on each platform and submitted bloodwork. Despite Dubin having well above normal testosterone levels, six of the seven platforms still offered the class-three controlled substance.

“ The AUA guidelines, which is our urology guidelines, recommend a level less than 300. None of the platforms here were using that as a marker. My testosterone level was 675,” Dubin pointed out.

The study, published in JAMA Internal Medicine, also found that only one of the seven platforms asked about recent heart problems or family planning.

Testosterone therapy can reduce sperm production and increase risks of blood clots, heart attack and stroke.

Dr. Joshua Halpern, a senior author of the study, said men tend to lose testosterone as they age but that could be related to other health issues.

“We know that low testosterone is associated with diabetes, diabetes and other cardiovascular risk factors,” he's said.

Halpern added that some people are born with low testosterone. However, he notes that testosterone replacement therapy can harm the body’s natural production of the hormone.

“A lot of men and even physicians sometimes don’t fully understand this. Testosterone is important for fertility. If we give men testosterone, we’re going to improve fertility whereas it’s in many cases the opposite.”

Once someone is prescribed testosterone replacement therapy, they could be on it for life.

For younger men who’ve been taking it and still want to have children, there is hope.

“There’s certainly ways that we as infertility specialists can help men kind of expedite that process,” Halpern said.

Halpern and Dubin said the study isn't meant to be a knock on telehealth, which is how the websites prescribe the therapy.

“For men’s health issues that have high stigma associated with them and associated with masculinity, telemedicine does have many benefits,” Dubin said.

The doctors said their research is about identifying possible pitfalls and the importance of following guideline-based care.