Testosterone Replacement Therapy: Hogwash or Fountain of Youth?

As I round middle age, I want to do everything possible to maintain my youthful exuberance. Testosterone therapy seems like the answer.

And it’s such a simple answer.  It’s natural.  After all, testosterone is something a man’s body already makes, it’s just that levels decline with age.  Just pop a pill, rub on some cream or inject in the hormone (good thing the suppository never caught on…) and you’re good to go.  Back to feeling 20 again with all the virility you could hope for.

All of the commercials would have you believe that low T (the hip term for having low levels of testosterone) is just a consequence of aging and has little to do with the choices we make. The image here gives you just a brief idea of how complicated the regulation of testosterone production is.  Given that it is one of the more powerful hormones, the feedback loops that turn on and turn off testosterone production are a massively complicated mess of arrows pointing every which way.

T supplementation completely destroys your body’s ability to regulate its own production.  And here’s the biggest kicker–low testosterone does NOT come from an inability to make testosterone.  Rather, it is the body screaming that there is a bigger problem present that needs to be fixed.  This, of course, boils back down to things like good dietary choices, exercise, stress management, avoiding certain environmental chemicals (BPA and phthalates top the list) and getting a good night’s sleep.

Surely by now you have seen the attorney ads on TV asking you to call if you or a loved one experienced a heart attack while taking prescription testosterone.  All of this hoopla was the result of a single study that found an increase in the rate of heart attacks in men taking prescription testosterone.

While this is certainly not a good thing, I have always considered using testosterone to fix low T levels a very bad idea any, regardless of whether or not it increases the risk of a heart attack.  Just like every other damn marker we think is the holy grail, low T levels are just one sign that the body is out of whack.  No different than high cholesterol, high blood pressure or obesity.

Just to further demonstrate that trying to fix low T levels with prescription testosterone, this particular review looks at a serious of case studies identifying links between increased clotting in the blood (thrombosis) and testosterone use.  While this is only a handful of cases, given that hormone use in women (birth control) is clearly linked to an increase in clotting, it should really come as no surprise.  Here are the details of the cases identified in the study:

  • There were 38 men and 4 women
  • 27 with deep venous thrombosis that led to a pulmonary embolism
  • 12 with osteonecrosis (a blood clot that led to destroyed bone)
  • 1 with central retinal vein thrombosis, 1 with amaurosis fugax (vision loss due to a blood clot) and 1 with spinal cord blood clot.
  • In 8 men whose TT was continued (don’t ask me why…), second thrombotic events occurred despite the use of Coumadin.

These are not good events, especially since all of these people were likely taking the testosterone in an attempt to improve his or her health.  Didn’t quite turn out that way.


For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.