The commonest fears regarding TRT are:
1) Prostate cancer
2) Cardiovascular Disease
First of all we have to know that prostate cancer occurs in men with low testosterone.
The type of cancer is not androgen based;
On the contrary, uncontrolled estrogens are responsible for the proliferation of cancerous cells in prostatic parenchyma.
Testosterone deficiency is accompanied by low muscle mass,that in turn leads to visceral fat accumulation.
This is a bad type of adipose tissue, linked to release of inflammation and cytokines release (Interleukin 6 & Tumor Necrosis Factor).
Visceral fat is plenty in aromatase enzyme, responsible for convertibility to estrogen
Moreover men with Hypogonadism are more likely to develop breast tissue enlargement, known as gynecomastia.
The direct correlation between the testosterone administration and prostatic malignancy has been debunked.
Top urologist, Professor Abraham Morgentaller from Harvard University, has explained this thoroughly.
Furthermore, his pioneering research explained that even use of testosterone while prostatic cancer occurs, can be managed.
Based on the androgen receptors theory, saturation of AR after a dose of testosterone will avoid extra assimilation of the main androgen; as long as estrogens are optimized and controlled
This is achieved by measuring the Estrone (E1).
One of the three types of estrogens,that have high affinity for cellular proliferation.
E1 can be blocked by using a sulfated compound, found plenty in broccoli (DIM).
Also a mild use of AI (Anastrozol) can prevent E2 from spiking.
Also the blockage of reducing T=> DHT by the 5 a reductase inhibitors (dutasteride, finasteride) will ensure there is no DHT to feed up the prostate.
The point with those medications, is that by blocking the one metabolite of T (DHT), will increase the other one (E2).
This is why we need to use an anti-estrogen while on anti-androgens.
Plus while on finasteride/ dutasteride we must not use any other compound besides testosterone.
No other AAS is able to be blocked (DHEA, DHT, mesterolone) by 5a reductase inhibitors.
The fact about testosterone and prostate is that T will be reduced to a potent androgen, dihydro testosterone (DHT) that is able to enlarge the gland (Benign Prostatic Hyperplasia- BPH).
However not all men can develop this under TRT, based on their PSA and genetic predisposition, family history.
Certainly BPH is not a malignant condition.
Besides, elevated PSA can be the result of
– Riding motorcycle
This is why usually after antibiotics PSA might lower and when there is absence of sexual intercourse for 72h.
About cardiovascular disease it’s known that low testosterone is associated with CVD.
First because testosterone deficiency is linked to visceral fat accumulation; that in turn is linked to insulin resistance (A1C>5.5%) and dyslipidemia (LDL>100).
But also with enlarged midsection circumference (>100cm).
These are 3/4 of factors consisting the MS (metabolic syndrome), leading to CVD.
Moreover, testosterone is able to synthesize NO (nitric oxide) the molecule that is able to vasodilator coronary arteries and provide O2 supply to myocardium.
Furthermore, the fingertips of T=> E2 will play protective role to arterial endothelium.
Raising HDL, the good cholesterol that cleans up the arterial lumen from cholesterol deposits.
For these reasons the main androgen and TRT is the foundation of youth in men’s health.
Men are aging physically and mentally because of Hypogonadism in middle age crisis.
Fortunately these myths have been dispelled.
The problem arises when patients either abuse testosterone, or have uncontrolled metabolites and aren’t optimized.
They definitely need to monitor their blood work by annual follow ups that include
TT, FT, E2, PRL, SHBG, DHEAS, PSA, CBC, HbA1C.
Mind that abuse of TRT can lower HDL, lead to erythrocytosis (most common side effect) OSA (snoring) kick systemic BP, nipple tenderness (aromatization by excessive estrogen) and potentially elevate lead to BPH/ PSA elevation.
TRT is not about getting jacked and having five erections a day; It is more than body composition and libido.
Testosterone is vital for metabolic reasons: Obesity, DM2, MS, depression, anemia, osteoporosis
It is up to the use for this wonder medication to become a poison and spread the bad reputation amongst medical community