Is TRT safe? FDA revises official guidelines [New research]

Chapters:

00:00 Intro

00:30 2 new scientific reviews

01:28 TRT concerns

01:55 Low testosterone levels

02:38 “Sports” TRT & side effects

03:47 My Online PT Course

04:11 Natural production supression

05:06 Should you get on TRT?

05:51 Blood work

07:02 Outro

Transcript:

What do Sydney Sweeney, Justin Bieber and testosterone replacement therapy have in common? They all got popular really quickly, but it’s not so clear that this was a good thing for society. TRT is becoming a lot more popular because a lot of content creators are espousing the benefits of higher energy levels, higher libido, and more muscle mass. However, testosterone is an anabolic androgenic steroid. Steroids have widely acknowledged negative cardiovascular health effects. So is TRT a health risk or is TRT actually good for your health?

Fortunately, we have two large new scientific reviews to answer this question, and because of this new evidence the FDA actually changed its official stance. In short, the new evidence quite unanimously supports the safety of testosterone replacement therapy. There are, in fact, more studies now finding positive effects of going from low to normal testosterone than negative effects, including for cardiovascular health. Because of the new traverse trial in particular, which is a very large scale, well-controlled trial, the FDA removed many of the warning labels associated with TRT. – A terrible mistake by the medical establishment. – On? Okay… Hi! –

The new scientific review also concluded that testosterone replacement therapy does not increase the risk of prostate cancer. This is a very common concern, but there is simply no compelling research at all to support it, and a lot of data showing there is no increase in risk. Broadly speaking, there are two concerns with TRT. The first concern is that testosterone from TRT is artificial. However, testosterone, chemically speaking, is testosterone, and it doesn’t matter whether it comes from a needle, your own testes or a patch on your skin. The second concern is that you increase the total amount of testosterone in your body. However, this is a matter of dosage. There is a well, well established dose response relationship of testosterone to all of its effects. This includes the positives and the negatives.

Having very low levels of testosterone is not a healthy physiological state to be in. Even aside from the low libido and vitality, low testosterone levels are also associated with insulin resistance and low levels of muscle mass, which can cause cardiometabolic problems. So basically what we see when we go from low to normal levels of testosterone is that, for one, the risk is very small because it’s a relatively small increase in absolute terms in testosterone, and secondly, the benefits and the risks kind of cancel each other out so that we get a null effect on all cause mortality. However, this does not mean that testosterone is harmless. When you increase the dosage further you get further effects, and higher dosages are also required to get steroid-like effects.

So as soon as you go over replacement levels of testosterone, remember the R in TRT stands for replacement, you get higher side effects and there is no safe way to get steroid-like effects and not the side effects. And this I think is currently the biggest problem with the rise in TRT popularity is that many people that are on “TRT” are not on actual TRT. They are what is sometimes called “sports” TRT, which is basically slang for low dose steroids, or low dose compared to what bodybuilders use. But these are super physiological levels. Even if you bring yourself to the top of the reference range, for example, which is still “the natural range” that can have significant side effects.

In the end, for you as an individual, whether you get these side effects or not, or whether you can even go over to normal range, and whether you have side effects primarily depends on your bloodwork. So it’s crucial whenever you are on TRT, whether it’s sports TRT or actual TRT, to do regular blood work to assess your risks. And in general, the first step for anyone even considering TRT is to have bloodwork done to check if you actually have low levels of testosterone. If you don’t have low levels of testosterone, there is nothing to replace. If you inject testosterone or you take testosterone via any means in general, it will suppress your natural production. So you cannot just take a little extra.

Testosterone that you take reduces your normal levels. So only when you take out all of your normal production and you get a higher level of total testosterone in your body via needles or patches or however you do it, that’s when you get positive effects. Like, it’s literally impossible to take just a little bit of testosterone. The only thing that will happen is that you suppress a little bit of your own production, and you end up with the same total level. So you have to completely get rid of your natural production to get the benefits of TRT. And for that reason, this is a very serious decision. Now you can go off TRT again and usually there is no long lasting damage over the course of a few weeks to months of gonadal suppression, but long term the risk of total gonadal permanent suppression, basically testicular death, is real, especially if you don’t use something like HCG to mitigate the risk.

So always get blood work done first, do the blood work twice to rule out measurement error from the first blood work, do the blood work fasted in the morning on both occasions and measure not just your total level of testosterone, but also your free testosterone. Importantly, you also don’t want to blindly go by your testosterone level, but you want to assess whether you actually have symptoms of hypogonadism, such as difficulty gaining muscle, low libido and generally low energy levels.

If you don’t have any of these symptoms, even if your levels are abnormally low by clinical reference range standards, you don’t really have a problem, so you don’t need to go on TRT necessarily. And conversely, even if your levels are borderline normal, but you do have these symptoms, you might still benefit from TRT, although you’ll probably have a harder time getting it from a doctor, especially if it’s one of the old school, more conservative doctors.

When you’re on TRT you want to perform regular blood work to assess the changes in your health. The main things you want to be aware of is the change in your lipid profile, your blood pressure, and your hematocrit. Testosterone stimulates significant production of red blood cells, which increases the proportion of red blood cells in your blood, and if this gets to very high levels, this can cause things like thrombosis and risks of blood clots. Typically, hematocrit should be below somewhere between 48 to 52%. It depends on which organization you look at. This is something you should discuss with your doctor and what your levels currently come from.

You should also assess your blood pressure. This is very easy to do. You can even do it at home these days with many devices. Make sure you do the measurement multiple times to rule out “white coat hypertension” which is that the first measurement is sometimes high because you’re not fully relaxed when you take the measurement. And then finally, you absolutely have to assess your lipid profile, which is your cholesterol levels. You want to make sure that your good HDL cholesterol does not tank too far, and you want to make sure that your bad LDL cholesterol does not rise too much. The lab and your doctor should provide you with reference ranges so that you can see how meaningful the change, if any, is in your blood work. This is really what determines whether testosterone replacement therapy for you is safe.

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