Over the past few years, many reports have appeared in the lay press about testosterone replacement therapy (TRT) in healthy aging men. You may remember a cover of Newsweek depicting the back of a muscular middle aged man bearing two testosterone patches advertising a story about the new technology replacing painful injections in the buttocks. With the arrival of Viagra, many men are now trying testosterone to help their flagging libidos keep up with their newfound ability to maintain adolescent-quality erections. And from the medical literature stories continue to appear exalting the muscle-boosting, fat-busting effects of TRT, not only in athletes, but also in sedentary healthy older men. In the face of all this positive publicity, there are an equal number of nay-sayers—mainly from academic centers and in health newsletters, not to mention your own doctor—who warn of the dangers of mucking around with your hormones and say that we don’t yet have enough long term studies to prove the safety and effectiveness of TRT. So what’s all the buzz about? And how, you probably are asking, can one separate the hype from reality?
The decision to start TRT is a complex and personal decision. There are many well-documented beneficial effects of maintaining a youthful level of testosterone, and we believe that the preponderance of evidence supports its use in most aging men. But our knowledge is incomplete—as it often is in clinical medicine—and so one must understand the many variables that factor into the decision to start TRT. The following sections present the factors that we believe every man must understand before he can make a truly informed decision.
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