What are the major concerns on starting Testosterone Replacement Therapy?

What are the major concerns on starting Testosterone Replacement Therapy?
February 13, 2023
  1. 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.
  2. 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
  3. 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