As with any medication-based therapy, testosterone replacement can produce side effects. Although many patients experience few or no complications, it’s important to understand the risks involved – however remote.
In some instances, patients don’t detect any side effects, but testing may reveal abnormal results that might cause problems later. Therefore, once the treatment protocol is launched, Dr. Bissoon asks all patients to report back in 4-6 weeks to re-evaluate lab results and any abnormal symptoms.
A One-in-a-Million Complication
An extremely rare complication, which occurs in 1 in 1,000,000 men, is an increase in red blood cell count or an increase in the Hemoglobin or the Hematocrit. If this happens, your doctor will present you with two remedies: (A) stop taking testosterone, or (B) donate blood every 3-4 months. Dr. Bissoon has encountered several patients with this side effect, and all of them chose to donate blood. Again, this is an extremely rare complication, but it’s imperative to test for it, since the condition causes an increase in blood viscosity (thickness) which, in turn, increases the risk of stroke and heart attack.
More Common Side Effects
One of the more common complications of testosterone replacement therapy is the conversion of testosterone to estradiol (estrogen), thanks to an enzyme called Aromatase. However, treatment to limit this conversion usually keep estrogen levels normal. High levels of estradiol are associated with abdominal fat, love handles, gynecomastia (enlarged breasts), reduced libido, fewer erections, insulin resistance, weight gain and water retention.
Because testosterone can also be converted to dihydrotestosterone (DHT), and high DHT is associated with hair loss, decreased libido, acne, liver cysts and prostate cancer, symptoms and levels of DHT should be monitored. If properly treated, complications arising from elevated DHT can be avoided.
Another concern is testicular atrophy, which can occur with the use of injectable and topical testosterone replacement therapy. Typically, this side effect does not become visible until the patient is 6-8 weeks into his treatment, but Dr. Bissoon will prescribe appropriate medication to prevent the condition from developing in the first place.
Once testosterone replacement therapy has begun, patients may notice a decrease in ejaculate and, if they also suffer from sleep apnea, the therapy can worsen this condition. During follow-up visits, however, Dr. Bissoon checks the level of PSA (high levels may be a sign of prostate cancer) and analyzes SHBG levels, since an increase in the latter would decrease the available testosterone.