Testosterone Replacement Therapy (TRT) for Older Men: What You Need to Know

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Testosterone Replacement Therapy (TRT) for Older Men: What You Need to Know

As men age, it is common for testosterone levels to decline gradually. While this is a natural part of aging, in some cases the drop is significant enough to cause a range of symptoms that impact quality of life. Testosterone Replacement Therapy (TRT) is a medically supervised treatment that can help restore hormonal balance in men diagnosed with Testosterone Deficiency Syndrome (TDS) or hypogonadism.

Signs and Symptoms of Testosterone Deficiency

A notable decline in testosterone can present through a range of physical, emotional, and cognitive symptoms, including:

• Fatigue or low energy

• Reduced muscle mass and strength

• Increased body fat

• Low libido or erectile dysfunction

• Depressed mood or irritability

• Cognitive issues (e.g., brain fog or difficulty concentrating)

• Decreased bone density

• Sleep disturbances

If multiple symptoms are present, it may be worth exploring TRT with a healthcare professional.

Getting Started: The Importance of Blood Tests

Before initiating TRT, a thorough evaluation is essential. Symptoms alone are not enough—testosterone levels must be clinically low and confirmed through blood tests taken at specific times (typically early morning, between 7–10 a.m., when testosterone is highest).

Baseline Blood Panel to Request:

1. Total Testosterone

2. Free Testosterone (bioavailable)

3. Sex Hormone Binding Globulin (SHBG)

4. Luteinizing Hormone (LH)

5. Follicle Stimulating Hormone (FSH)

6. Estradiol (E2 – sensitive test)

7. Prolactin

8. Complete Blood Count (CBC) – to monitor hematocrit and hemoglobin

9. Lipid Panel – for cholesterol (LDL, HDL, triglycerides)

10. PSA (Prostate-Specific Antigen) – to assess prostate health

11. Comprehensive Metabolic Panel (CMP) – for liver/kidney function

12. Thyroid Panel (TSH, Free T3, Free T4) – to rule out thyroid issues

Forms of Testosterone: Understanding Your Options

TRT comes in several delivery forms, each with its own pros and cons:

• Injectables (e.g., Testosterone Cypionate, Enanthate)
  Typically administered weekly or biweekly. Provides strong, reliable dosing, but may cause hormonal fluctuations if not dosed frequently enough.

• Topical Gels/Creams
  Applied daily to the skin. Convenient, but absorption rates vary between individuals and there is a risk of transferring the hormone to others via skin contact.

• Transdermal Patches
  Offer steady delivery but can cause skin irritation.

• Implantable Pellets
  Inserted under the skin every 3–6 months. Low maintenance but less flexible if dosage adjustments are needed.

• Oral/Buccal
  Less commonly prescribed due to inconsistent absorption and potential liver strain.

Choice of administration should be guided by patient preference, response, and lifestyle—under physician supervision.

Benefits of TRT (When Properly Managed)

For men with medically confirmed low testosterone, properly administered TRT can:

• Increase energy and vitality

• Improve libido and sexual function

• Enhance mood and mental clarity

• Boost muscle mass and reduce fat

• Support bone density

• Improve insulin sensitivity and metabolic health

Potential Risks and Dangers of Poorly Managed TRT

TRT is not without risk, especially if undertaken without proper supervision or monitoring.

Key Risks:

• Elevated Hematocrit:
  TRT can increase red blood cell count, which raises hematocrit. High levels (>54%) increase the risk of blood clots or stroke. Regular CBC monitoring is vital.

• Increased LDL Cholesterol and Reduced HDL:
  TRT may negatively impact lipid profiles, particularly if the patient has underlying cardiovascular risk factors.

• Suppression of Natural Testosterone Production:
  Exogenous testosterone can suppress the body’s own production, affecting fertility and testicular size.

• Elevated Estradiol:
  Testosterone can aromatise (convert) into oestrogen. Excess oestradiol can cause water retention, mood swings, or gynaecomastia (breast tissue development).

• Prostate Concerns:
  While current evidence does not link TRT to prostate cancer, PSA levels must be monitored to ensure safety.

Final Thoughts: A Clinical Approach is Essential

TRT can offer life-changing benefits to older men suffering from testosterone deficiency—but only when administered responsibly, with proper diagnostics and ongoing medical supervision. Self-medicating, ignoring bloodwork, or chasing “high-normal” levels without clinical need can lead to serious health issues.

Men considering TRT should work with a hormone-literate provider, undergo appropriate testing, and commit to regular follow-ups to optimise benefits while minimising risks.

 

 

Compiled from various internet sources.

 

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