The phenomenon of younger men turning to testosterone replacement therapy (TRT) to boost their “T levels” has been in the spotlight recently thanks to media reports and social media influencers.
Testosterone is a hormone critical to male health, influencing muscle mass, mood, cognition, libido and energy levels. Artificially raising testosterone levels through supplementation when levels dip seems logical. But is it?
Clearly, a large amount of research points towards beneficial effects of TRT for men with deficiency, including increased muscle mass and reduced fat mass, improved sexual desire and performance and better overall quality of life. But these findings come mostly from research in older men, leaving important questions unanswered about the effects of TRT in younger men. (It should be noted that TRT is not the same as anabolic steroids, which are drugs used purely to increase muscle mass.)
As men age – typically from age 30 – testosterone levels decline. Some estimate levels to drop by 1%-2% per year, although the specifics have not been resolved. This decline happens much faster if the person has certain diseases, such as obesity, diabetes and inflammatory diseases – the kinds of diseases that tend to accumulate as we age.
In healthy men, the age-related decline probably doesn’t have a negative effect until men are in their 70s and 80s. So low testosterone is not a natural consequence of ageing that all men will face. And it really is the occurrence of certain diseases that has a big impact on T levels.
Testosterone deficiency in younger men that requires medical intervention is relatively uncommon. But it can occur with specific genetic conditions such as Klinefelter syndrome, where males have an extra X chromosome, which can interfere with testosterone production and development.
Despite this, recent studies suggest a generational decline in testosterone levels, with young men today having lower testosterone than those in past generations. These reductions might be due to changes in environmental and lifestyle factors: higher stress levels, poor diet, lack of exercise and increasing obesity rates can contribute to hormonal imbalances.
Adding to this, chemicals in plastics, certain pesticides and processed foods contain hormone disruptors, which may also play a role. These changes appear to have contributed to lower testosterone even in otherwise healthy young men.
Whether this generational decline affects overall health has yet to be proved. And even with these declines, levels are often still within the so-called normal range.
While TRT might seem like a solution to fatigue, low mood, anxiety and decreased muscle mass, it’s essential to consider the underlying reasons for low testosterone and whether lifestyle changes might be more effective and sustainable than hormone replacement. For many, changes such as improving diet, reducing stress, exercising regularly and getting enough sleep can have a big effect on testosterone levels and overall wellbeing.
Hidden dangers
Historically, testosterone therapy was thought to increase the risk of prostate cancer and heart attack. Recent clinical trials have provided strong evidence against this. Yet most of the safety studies on TRT have been conducted on older men whose testosterone levels have declined. Younger men, particularly those under 30, have not been widely included.
The side-effects and potential long-term health risks for older men can be quite different from those faced by younger men. This means that the effects of TRT use in young men are still uncertain and until longer-term safety studies are performed, many dangers may not yet be known.
Despite how easy it is to get testosterone levels assessed these days, with many online clinics offering home-test kits, defining what is a normal testosterone level is a bit more complicated.
Testosterone concentrations in the blood fluctuate throughout the day, year and temporarily with different cues. For example, an infection, stress and poor sleep can all temporarily lower T levels. If the decision to use TRT is based on that one measure – particularly if that measure was done incorrectly – there is a risk of unnecessary treatment.
There is also the danger that if testosterone levels are boosted too high, it can be harmful to health.
Testosterone therapy can increase red blood cell count, which may thicken the blood, making it harder for the heart to circulate blood throughout the body. This can lead to complications such as high blood pressure and elevate the risk of blood clots. Blood clots can lead to life-threatening conditions like deep vein thrombosis, pulmonary embolism, heart attack or stroke.
Very high levels of testosterone (particularly those above the normal range) through supplementation can cause the heart muscle to grow, a condition called cardiac hypertrophy. Over time, this can increase the risk of heart disease and other cardiovascular issues. Since young men are less likely to be screened for heart conditions, TRT use without careful monitoring may elevate the risk of sudden cardiac events.
For young men who may want to have children in the future, TRT can be an issue. TRT suppresses the body’s natural testosterone production and disrupts the hormone signals necessary for sperm production, leading to infertility. In many men, this is reversible once treatment has stopped, but in some, the infertility is permanent.
There are also some cosmetic side-effects. Increased testosterone can stimulate oil production in the skin, potentially leading to severe acne, which may cause both physical discomfort and psychological distress. And higher levels of testosterone, particularly in young men genetically predisposed to male pattern baldness, can accelerate hair loss, which may affect their self-esteem.
Before jumping into testosterone replacement therapy, young men should confirm they’re truly testosterone deficient with a healthcare provider and understand all the personal risks alongside the potential benefits. Since lifestyle factors often play a big role, making small changes may be a smart first step before medication. And if they do start TRT, regular monitoring by medical professionals is key to catching any side-effects early and keeping health on track.
Daniel Kelly does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
