What are the major concerns on starting Testosterone Replacement Therapy?

February 13, 2023
- Cardiovascular (CV) risk factors. Although low T is a risk factor for cardiovascular disease including increased incidence of MI, stroke and possible CV-related mortality, CV risk factors should be assessed [hypertension, Diabetes Mellitus, Dyslipidemia (cholestrol and fat in the blood), smoking, family history, previous history of cardiovascular events]. It is to be noted that there is no definitive evidence that TRT increases or decreases the risk of CV events.
- Future fertility. For those who are still planning future reproduction, testosterone cessation should occur. Patient to be informed of the variable time course to recover sperm in the ejaculate. While 2/3 of males recovered sperm in the ejaculation within 6 months of exogenous testosterone cessation, 10% failed to do so until 2nd year after cessation
- Prostate cancer. There is absence of evidence linking testosterone therapy to development of prostate cancer, although this is still a potential risk and therefore PSA monitoring is necessary while on testosterone therapy