For any man who is new to testosterone replacement therapy, his primary concern will almost always be the side effects of testosterone use. This is an understandable concern, especially when the hormone has received so much negative press for nearly a century. Fortunately, the vast majority of the negative attributes simply aren’t true. In fact, with proper therapy and a sound protocol, there is no reason any man should suffer from the side effects of testosterone. The key to problem free therapy is simple, understand the hormone, supplement with the proper doses and understand how to balance hormone levels with a thorough understanding of preventative measures. This may sound difficult, but with an educated physician it is more than possible.

The Side Effects of Testosterone – Good News

With any medication, there is a potential for negative side effects. It does not matter what medication we’re talking about, a possible negative reaction exist. When you receive a prescription or even purchase an over the counter medication from your local drug store, you are placing a foreign substance inside your body that it is unfamiliar with. What does this have to do with the side effects of Testosterone? The good news is testosterone is not a foreign substance to the human body. This is a hormone you have been making your entire life, and it is one that is essential to your overall health and wellbeing. Granted, when you supplement with testosterone, your body didn’t make it, but there’s even more good news. The human body will make no distinguishing difference between the testosterone it makes or the testosterone you take. Carbon for carbon, they are identical.

The Primary Side Effects of Testosterone – Estrogenic:

The primary side effects of testosterone include gynecomastia (male breast enlargement) and water retention. If water retention becomes severe, this can promote high blood pressure. These primary side effects of testosterone are estrogenic in nature. As men, we need estrogen, but too much can be quite problematic. The possible increase in estrogen is due to testosterone converting to estrogen. This occurs due to the hormone’s interaction with the aromatase enzyme. The rate of aromatization is greatly dependent on genetics and how much testosterone you’re taking. However, men with large quantities of excess body fat will typically aromatize at a higher rate than men who are at a healthy weight. This doesn’t always hold true, but it does far more often than not.

In order to combat the estrogenic side effects of testosterone, many men will find the use of an Aromatase Inhibitor (AI) like Anastrozole to be extremely beneficial. AI’s function by inhibiting the aromatase process, which will in turn reduce serum estrogen levels in the body. This will protect any man from the estrogenic side effects of testosterone. How much AI that’s needed can vary greatly from one man to the next. Many men do extremely well on 0.5mg one to two times per week. Some men only need 0.25mg per week; however, approximately 25-30% of all men will not need an AI. An AI is only needed to reduce estradiol when levels go above the optimal range. If an AI is used when estradiol isn’t high and is already optimal, it will only lower estradiol below where it needs to be. Men need estrogen at a certain levels and if levels are too low, this can lead to many problematic symptoms.

Androgenic Side Effects of Testosterone:

The testosterone hormone can promote androgenic side effects such as acne, hair loss and body hair growth. However, the androgenic side effects of testosterone are highly dependent on genetic predispositions. For example, if you are predisposed to male pattern baldness, testosterone can make you lose some of your hair. However, if you are not genetically predisposed, hair loss is impossible. For the predisposed man, he is going to lose his hair no matter what he does; the use of testosterone may simply speed it up. While such effects are possible based on genetic predispositions, they are also highly dependent on doses. In a therapeutic setting, it is highly unlikely that the androgenic side effects of testosterone will be a problem. Androgenic side effects are far more commonly associated with supraphysiological doses of testosterone, such as those used by performance enhancing athletes.

The reason androgenic side effects exist is due to the testosterone hormone being metabolized by the 5-alpha reductase enzyme. This leads to the testosterone hormone being converted to dihydrotestosterone (DHT). When testosterone doses are managed responsibly, such effects should not be a concern. If in rare cases problems arise, the use of a 5-alpha reductase inhibitor such as Finasteride can be implemented. However, such medications should be viewed as a last resort as they can cause severe androgen imbalances.

The Side Effects of Testosterone – Lipids:

The use of testosterone can possibly affect cholesterol levels. Most all forms of testosterone will reduce HDL cholesterol (good cholesterol), but the total effect is normally insignificant. There are, however, exceptions to this rule:

• The use of testosterone can decrease HDL cholesterol by as much as 20% when its use is combined with an AI. However, this is more than manageable with healthy lifestyle choices.
• The use of oral testosterone, specifically Methyltestosterone can have a much greater impact on lipids. Methyltestosterone will significantly reduce HDL cholesterol with or without an AI and can easily increase LDL cholesterol (bad cholesterol) by as much as 30% with or without an AI. 

In order for the side effects of testosterone surrounding lipids to be avoided, it is recommended that the individual’s diet be rich in omega fatty acids and low in simple sugars and saturated fats. Regular cardiovascular activity is also recommended. These are things that should be considered with or without testosterone supplementation. Compounds like Methyltestosterone should also be avoided; while once a valuable tool, it truly has no place in testosterone replacement therapy in the modern age.

Important note – while the use of testosterone can potentially skew cholesterol levels, data has shown that men who optimize testosterone levels through therapy typically display healthier lipid profiles than men who ignore their low levels. In fact, despite the use of testosterone possibly affecting lipids negatively, prolonged low testosterone has been linked to increasing the risk of heart disease.

Testosterone & Testosterone Suppression:

The use of exogenous testosterone will suppress natural testosterone production. In fact, of the possible side effects of testosterone, this is the only one that is absolutely guaranteed. When exogenous testosterone enters the body, this signals to the body that it has no need to make its own. As a result of this suppression, the individual’s testicles will experience a bit of atrophy (loss of fullness). This is unavoidable in all men who use testosterone for any reason.

While natural testosterone suppression will occur, for the low testosterone patient this is not a concern. A man with low testosterone does not produce enough testosterone on his own to begin with. If suppressing what little he has left is an idea that bothers him, he needs to understand he will have to suffer from low levels. As for testicular atrophy, this does not mean the testicles will disappear; this simply refers to a loss of fullness and will have no negative affect on one’s wellbeing. However, the use of HCG during testosterone therapy will prevent testicular atrophy as it will keep natural testosterone production online. If the individual suffers from secondary hypogonadism, HCG is normally recommended for numerous reasons. However, if he suffers from primary hypogonadism, it will have very little to no affect.

False Side Effects of Testosterone:

There are many purported side effects of testosterone that have for years been deemed almost guaranteed, but the problem with this guarantee is that they simply do not exist. The following is a list of side effects that have been reported to be true but have been done so with no medical or scientific backing:

• Prostate Cancer: Recent studies have shown that men who undergo testosterone therapy are far less likely to develop prostate cancer than men who do not.
• Stroke: There has never been a single reported stroke linked to testosterone therapy or testosterone use at any dose.
• Heart Attack: There has never been a single reported heart attack linked to testosterone therapy or testosterone use at any dose.
• Increased Anger & Violence: Data has shown that men who have low testosterone are normally far more irritable and angry than men who are using testosterone.