There is plenty of hype right now about testosterone replacement therapy. There is also plenty of misconceptions about the risks and benefits of testosterone therapy. My goal with this article is to dispel those myths, and equip you with the tools you need to make educated decisions regarding your own use of testosterone therapy.


Testosterone does not cause prostate cancer or heart disease. There were a couple of misleading studies on that years ago. There are many studies that show that testosterone is actually protective against those two diseases.

In fact, just a couple of months ago a 10-year study in Sweden concluded the same thing. The study comprised of 1000 men, average age of 60, all with low testosterone levels. Half was given testosterone for 10 years, half given a placebo. After 10 years, 2.3% of the group who was given testosterone developed prostate cancer. In the placebo group, 6.9% developed prostate cancer. Their cancers were also more aggressive than the few that were on testosterone therapy.

As for heart disease, which is the number one killer of men and women, think of the heart as a muscle. Testosterone promotes muscle growth. In fact, you have more receptors in your heart for testosterone than you do in your testicles. Of the thousands of men I’ve treated with testosterone over the past 32 years, I’ve never seen one develop heart disease from testosterone therapy. The only thing I’ve seen is a handful of men develop a little swelling in their legs with it.

Isn’t it normal to have low testosterone as you get older?

I get this question all of the time. Yes it is! But it’s also normal to lose your hearing and your vision. Would you not want to replace them if you could safely? However, when getting bioidentical hormone replacement, you need an experienced physician doing it because there can be complications from it, and strategies to avoid these complications. A couple of real obvious ones are the conversion from testosterone to estradiol (which can be dangerous for a man’s heart and prostate).

Another one is building up your red blood cell count and your blood becomes too thick. There are strategies for when you should go on and off testosterone, and the use of other medications to prevent the shutting down of your own ability to produce it.

When working up a patient up for testosterone, I have to determine if its primary hypogonadism (testicular insufficiency), or secondary hypogonadism (pituitary insufficiency). This guides me in how I replace or stimulate your body’s own production.

Low testosterone is more prevalent now than in year’s past

There is no doubt that men have higher rates of low testosterone today than in the past. Poor nutrition, less exercise, more stress, less sleep and environmental toxins contribute to the fact that testosterone levels are much lower than they were just a few years ago. And remember testosterone therapy is not just for a sagging libido or erectile dysfunction. It promotes energy, muscle growth, bone growth, mental clarity, interest in things, and skin and bone health. I’ve seen low T in men cause depression, anxiety, irritability (grumpy old man syndrome), achy joints, increased abdominal fat, poor memory, and just a general decline in their overall health.

Evaluating testosterone also gives me the opportunity to do the other screenings I need to do on a man like prostate health, heart health, and brain health. I also get to talk to them about a healthy lifestyle in general.

The different therapies for men

Testosterone replacement therapy alternatives include creams (my least favorite), injections (intramuscular or subcutaneous), and pellets (my favorite). These patients need to be monitored by an experienced physician, not only versed in the workup and treatment of low testosterone, but in other aspects of men’s health in general.

First things first

Men’s Health Month is the perfect time for a man or one of his loved ones to schedule an appointment with their health care provider, especially if they have noticed symptoms. Before a man starts testosterone therapy, they should have a complete physical and adequate lab work.

Quick side note: I see many men who have been told they have a normal testosterone level. The problem with this is that the normal range is so wide that normal is hardly ever optimal!

Be sure to check a free testosterone level, as this is the only testosterone that is active. Your total testosterone may be mid-range to normal, but your free testosterone may be really low. One of the most important things is your symptoms.

Hormones are complicated. When done right, they can be life changing.