Testosterone Wonderpill or overkill? Part Two: Why I decided to Join the T-party: AJ’s story

The following article explores the Testosterone Replacement Therapy from the point of view of a client taking TRT. To read more about TRT and the a review of the scientific evidence see Part One…

AJ is in his mid 50s but has the physique most 30 something pro-athletes would envy. He works hard, is a successful entrepreneur, and has bags of energy. Is this down to testosterone shots?  

AJ has been taking TRT for about ten years. I asked what influenced his decision to begin a therapy that is a long-term commitment? One side effects of taking instead of  making testosterone is the brain sends the body a signal saying, ‘we have enough,’ and turns off natural production (more on side effects later).

Surprisingly, AJ did not fit the marketing stereotype of the middle-aged, grumpy fat man who has lost his libido, is disillusioned with life, and is seeking a magical bullet (or pellet) to restore muscle mass, vitality and vigour.

Prior to his decision to take testosterone, AJ was regularly working out, took a healthy approach to diet, and although he was in the end game of a long-tem relationship, was generally a positive and confident person.

In sum,  he just “felt something wasn’t right;” that he wasn’t on his best form.  He heard about TRT from a radio advert and decided to give it a shot (no pun intended).  The clinic ran some basic blood tests, informed him his testosterone levels were below optimum, and recommended testosterone injections.

According to AJ the procedure is pretty straightforward. About once a week, he goes to a clinic where the testosterone is injected intra-muscularly into his buttock. (It doesn’t hurt). He has his blood levels checked every 4-6 months and takes additional medication, an estrogen blocker, to prevent the testosterone being transformed into estradiol, a form of estrogen.

Quick science fact;  In men, a small portion of testosterone is naturally converted into estradiol by an enzyme known as aromatase. It’s normal, but imbalances can occur.  When estradiol is too high and testosterone too low, symptoms occur such as: a more feminine body shape, gynecomastia  (man-boobs); less muscle; truncal obesity (paunch). As well as, apathy, lower libido, labile emotions (mood swings) and less drive. (Ok the terms ‘man-boobs’  and ‘paunch’ are not scientific terms… )

Clearly, the idea of rebalancing testosterone levels has appeal. Something the pharmaceutical industry is quick to capitalize on. In the USA $3.8BN was spent on testosterone supplements (injections, pellets, pills, patches, gels and creams); income mostly derived from direct-to-consumer adverts encouraging men to “Ask your Dr about testosterone replacement therapy”. 

For the record, just having ‘Low testosterone’, as opposed to hypogonadism, is not a recognised medical condition. In fact, about 85% of men prescribed testosterone would not actually meet the clinical requirements for testosterone therapy.  

Back to AJ’s story. As mentioned, while his testosterone levels were not optimal, he did not fit the stereotypical Low T patient. I wondered why not work on increasing Testosterone naturally first?

There are a number of clinically proven ways to increase testosterone via lifestyle. For example, avoiding xenoestrogens, engaging in certain types exercise, incorporating adaptogenic herbs and tweaking diet. The advantage of this approach is there’s no risk of side-effects.

I asked AJ if  his Naturopath discussed lifestyle as a first option? He said “No.”  After contemplating, he suggested since the ND was aware that he was “already doing many of the right things, such as working out and consulting a dietician he probably didn’t think it was necessary”.  Also, in fairness, the scientific field is more advanced than 10 years ago; more clinical data on the effects of environmental endocrine disruptors, diet and epigenetics is available.  Plus, while testosterone therapy is not a quick fix; it does increase levels more rapidly than lifestyle changes. 

So, after ten years of TRT, what effects did AJ experience: Good, bad, indifferent?

First, I asked if he experienced any negative side effects?  Side-effects can include increased aggressiveness, anxiety, impulsivity, mood swings, sleep disturbances, as well as undesirable physical changes such as acne, oily skin, shrunken testicles, gynecomastia, and hair loss to name but a few.

AJ did not experience any noticeable side effects.  He does say he is more easily distracted and less focused than he used to be. Although he is not certain if this due to the testosterone, or more likely, the unrelenting digital media overload we all experience. 

What about benefits? Did AJ experience any noticeable benefits. I posed questions based on the research (see part one: Testosterone wonderpill or overkill?) 

To summarize, AJ did not observe an improvement in memory, or the way he manages stress.

In line with findings from neuroimaging research, viz. activation in the oribitofrontal cortex, AJ  has noticed a slight increase in risk-taking. This is not “crazy threat to safety” or “illegal” risk but more in terms taking a chance on business opportunities.  However, he is not sure if this is down to life experience, and a natural tendency to stay ahead of the curve.

AJ claims he is slightly more confident, but he was already confident, and  again he is not sure if this is just a result of life experience.

He does report feeling more motivated, but he concedes this could be the effects of his exercise routine. 

On the whole, AJ says he “feels good, has good energy, sleeps well, is motivated by his work, and is positive”.  A poster Boy for testosterone therapy?

I’m not convinced. There is caveat in assuming these benefits are down to TRT. AJ already had, and continues to have, a very healthy lifestyle. Such a lifestyle naturally lends itself to good energy, good sleep, and effective stress management. With these lifestyle variables unaccounted for, it would be imprudent to conclude all this good stuff is a direct result of weekly testosterone injections.

Unsurprisingly, AJ is not prepared to quit his healthy lifestyle to test this hypothesis.  Nor is he prepared to stop the therapy. At the moment he says the combination seems to be working, but he concludes, “You got to do the work”.

AJ’s story leaves me wondering if TRT is the fountain of youth fix it is purported to be?

The scientific research finds no evidence to show it improves memory or reverses dementia.  However, testosterone has been found to increases confidence, drive and motivation.  Anecdotal evidence from AJ’s experience supports this; although changes are subtle, and difficult to disentangle from other variables.

Testosterone helps build muscle mass and improves sexual vitality. Undoubtedly, being physically fit and vital has a positive effect on mood which overspills into daily life. 

It would seem therefore, TRT alone is not a magic bullet. However, in conjunction with a healthy lifestyle, and effective stress management, testosterone has potential to greatly enhance wellbeing. To quote AJ “You got to do the work.”

Irrespective of the opinion that TRT clinics are cashing in on the insecurities of men at transitional stage of life; at least TRT has opened the door to encouraging men to acknowledge they, like women, also experience hormonal changes, and there is nothing wrong with seeking help for this.