A Men’s Health Urologist Weighs in on Testosterone Replacement Therapy

Keck Medicine of USC men’s health specialist Kian Asanad, MD, answers commonly asked questions about the risks and benefits of testosterone replacement therapy.

As women go through menopause, some men may go through a similar experience called andropause, which results from a decrease in their natural testosterone production. There are many therapies on the market for men in this stage of life, but the only one meant to be prescribed and monitored by a doctor is testosterone replacement therapy.

While general awareness and understanding of testosterone replacement therapy has improved in recent years, many people still have questions. Is testosterone replacement therapy safe? What are the side effects of testosterone replacement therapy? How is testosterone replacement therapy different from over-the-counter drugs and supplements?

Kian Asanad, MD, a urologist specializing in men’s health at USC Urology, part of Keck Medicine of USC, answers these questions and more.

How do you know if you have low testosterone?

Some studies suggest that testosterone begins to dip between the ages of 40 and 60, and the most common symptoms include:

• Low energy.
• Impaired sexual desire and performance issues.
• Depression or brain fog.
• Loss of muscle mass.

However, other conditions, such as underlying depression or stress, can also cause these symptoms.

“It’s a good idea to see a doctor for a two-part blood test to confirm the diagnosis,” Dr. Asanad says.

He adds that newer studies have demonstrated that it is actually the accumulation of other medical problems as men get older (such as diabetes, high blood pressure, obesity and metabolic syndrome) that results in decreased testosterone levels. In other words, if men stay healthy as they get older, they can maintain normal testosterone levels as they age.

Why not just take an over-the-counter remedy?

Over-the-counter testosterone remedies commonly advertised on TV are mainly vitamin and herbal supplements. However, a prior study has found that some of these supplements actually do contain testosterone or testosterone precursors, which should only be taken under a doctor’s supervision.

“Exogenous testosterone therapy can make men infertile and lower their sperm counts,” Dr. Asanad says. “So, if a 35-year-old man is thinking, ‘I need an energy booster’ and starts taking a testosterone therapy from the plethora of online direct-to-consumer platforms available, it could seriously affect their fertility. Without appropriate counseling, they may not be aware that their sperm count has gone down.”

He adds, “In cases where men want to preserve their fertility potential, I recommend alternative testosterone therapies, such as clomiphene citrate, which help boost natural testosterone production.”

Does testosterone replacement therapy cause cancer?

“No,” Dr. Asanad says. “An FDA study has concluded that testosterone replacement therapy does not increase a patient’s risk of developing prostate cancer.”

That doesn’t mean everyone can or should use it, though.

“If someone is currently living with low-risk prostate cancer or they had a history of prostate cancer and it has been completely treated, testosterone replacement therapy is more nuanced and complex. This should typically only be prescribed and monitored by their urologist,” Dr. Asanad says.

How is testosterone replacement therapy administered?

Testosterone replacement therapyis most commonly given as a topical gel or an injection, though “there’s also pellet therapy and newer oral testosterone agents,” Dr. Asanad says. As a result, men can choose whatever form of therapy best suits their lifestyle.

What if I’m too embarrassed to ask for it?

Dr. Asanad wants every patient to know that a urologist’s office “is a very safe space.” There’s not much your urologist hasn’t seen.

He adds, “Many men suffer from low testosterone, and it can significantly impact their quality of life.”

The good news is, low testosterone is easily treated, with many different options available to suit each patient’s unique needs and life goals.

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