Testosterone therapy: Needle or risk?

Testosterone deficiency affects not only libido but also general quality of life. It can manifest itself with symptoms such as weakness, loss of muscle strength, forgetfulness, and depressive mood. However, the fact that these symptoms are due to low hormone levels should be confirmed with at least two separate blood tests performed in the morning hours. If the total testosterone level is below 300 ng/dL, doctors may consider hormone supplements. (Source: Mayo Clinic – Testosterone therapy: Potential benefits and risks) However, the following risk factors should definitely be evaluated before starting treatment: - PSA (prostate) test - Hematocrit level - History of heart disease - Sleep apnea

- Prostate enlargement

What options are there if natural methods are not enough?

The most common method is intramuscular injections of testosterone enanthate or cypionate. They are applied once a week or every two weeks. Gel formulations are applied to the skin and absorbed and used daily. Less common methods include:- Subcutaneous “pellet” implants

- Intranasal gel forms. Each method has its own advantages and disadvantages. While there may be a risk of infection to household members in those using gel, sudden fluctuations in hormone levels may be seen in those using needles. (Source: Cleveland Clinic – Testosterone replacement therapy)

Things to know before deciding

- Testosterone treatment is usually lifelong. If the drug is stopped, the hormone level drops again. - The testicles' own production can be suppressed, which stops sperm production, especially in young individuals. - Side effects such as acne, hair loss, irritability, and breast enlargement can be observed during treatment. - In some people, the SHBG (sex hormone binding globulin) protein increases, which causes a decrease in active testosterone.

- The body may develop resistance to the hormone over time or its effectiveness may decrease.

In conclusion: Hormone replacement is not a simple “rejuvenation” method, but a serious treatment that is determined by clinical judgment. The risk-benefit ratio must be evaluated individually for each patient. (Source: Harvard Health – Testosterone replacement pros and cons)

Risks and monitoring of hormone replacement

Testosterone treatment is not a simple supplement, but an intervention that affects multiple systems in the body. Close monitoring is necessary, especially because of its effects on the cardiovascular system, prostate health and blood clotting system. The following tests should be performed before and after treatment: - Total and free testosterone - PSA (prostate specific antigen) - Hematocrit and hemoglobin - LH and FSH hormones - Liver function tests After starting treatment... - In the first 3 months - Then, retesting should be done every 6 months. Treatment may be terminated if the hematocrit level exceeds 54% or if the PSA value shows a sudden increase.

(Source: Endocrine Society – Clinical practice guideline on testosterone therapy)

Common mistakes in testosterone therapy

- Non-prescription use for bodybuilding purposes - Starting without PSA control - Using it without any complaints just to "slow down aging" - Not adjusting the doses individually - Thinking of the treatment as "doping to build muscle"

(Source: European Urology Journal, 2021)

Does testosterone treatment reduce sperm?

Hormone therapy can reduce sperm production by the testicles by suppressing LH and FSH signaling in the brain. The risk of infertility is over 70% with long-term use.

If treatment is considered for young individuals, this risk must be explained and, if necessary, the option of sperm freezing should be considered. (Source: Fertility and Sterility, 2022)

Is nutritional support required during treatment?

Testosterone metabolism is sensitive to micronutrients such as zinc, vitamin D, Omega-3 and magnesium.

Taking these supplements in a balanced manner during the treatment process can increase the effect on muscle strength and mood. However, instead of high-dose supplements, recommendations based on blood tests should be preferred. (Source: Journal of Endocrinology and Metabolism, 2020)

Tomorrow: Blood Pressure

- Even if your blood pressure is normal, you may be at risk of stroke. - The 3 biggest mistakes made by those who want drug-free treatment. - Which one works, hibiscus or potassium? What does science say? - The 5 most commonly used blood pressure medications, the 5 most common mistakes. - Hidden blood pressure may be behind a morning headache.

- Numbers are not the only way to understand a blood pressure crisis.