Side Effects of Hormone Replacement Therapy for Men

Hormone replacement therapy is a medical regimen designed to alleviate the effects of low testosterone due to aging. Patients with certain pre-existing conditions should not take synthetic testosterone, and hormone replacement therapy can cause a number of side effects, some of which can be fatal.

Identification

• In men, natural testosterone production peaks between the ages of 18 to 25 and begins to decline thereafter at a rate of about 2 percent yearly. This natural degeneration can lead to a decrease in muscle mass and bone density, loss of energy, decreased libido, difficulty remembering and concentrating, fatigue, erectile dysfunction, and a decline in overall mental health and well-being. Doctors use hormone replacement therapy to alleviate or reverse these effects and improve the quality of life in men as they age.

  During hormone replacement therapy, doctors can prescribe synthetic testosterone that can be administered by intra-muscular injection, taken orally or applied to the skin. Dosages vary depending on mode of treatment; typical injections, for example, range from 50 to 400 mg, every two or three weeks.

Contraindications

• Testosterone can enlarge the prostates of elderly men and should not be taken by patients suffering from or prone to prostate cancer. Additionally, men with breast cancer and patients with liver disease, coronary disease, chest pain, high cholesterol or anyone who has had heart failure in the past should consult a doctor about these conditions before taking synthetic testosterone. Diabetics may have to change their insulin dosage, because testosterone can affect blood sugar levels.

  Those allergic to hormones or any of the ingredients (injectable testosterone contains benzyl alcohol) should avoid use.

  The Federal Food and Drug Administration (FDA) has classified testosterone as a pregnancy Category X drug, which means that it is known to cause birth defects in unborn fetuses.

Hepatotoxicity

• Long-term testosterone use can result in peliosis hepatitis, a sometimes fatal condition characterized by the formation of blood-filled cysts inside the liver and/or kidneys. Certain oral forms of synthetic testosterone are modified by a process called 17-alpha-alkylation (attachment of an alkyl group). This modification increases the longevity of their effects by making it difficult for the liver to break them down, but can cause liver toxicity. Testosterone can alter liver levels, and may cause the body to retain excess sodium and water, which puts additional strain on the liver and kidneys.

Other Physiological Side Effects

• Testosterone use can alter blood serum cholesterol levels, including the reduction of good cholesterol, and might cause hypertension, which may lead to heart disease or stroke. It can also cause jaundice (yellow skin), difficult urination (due to prostate enlargement), acne, greasy skin and edema (swelling of feet and ankles).

  The psychological effects of testosterone can include aggression, irritability, depression, headaches, excitability and moodiness.

Sexual Dysfunction

• Testosterone displays strong androgenic (masculinizing) effects, which can include a further deepening of the voice, and the growth of excess facial and body hair. Excess testosterone can also convert to estrogen (via a natural enzymatic process called aromatization), which may result in gynecomastia (male breast enlargement), which might require surgery to correct.

  Men on hormone replacement therapy may also experience altered libido and erectile dysfunction.

  Additionally, long term use of exogenous (non-bodily produced) testosterone can dampen the body's ability to produce testosterone naturally. When hormone replacement therapy is discontinued, these patients might have to use human chorionic gonadotropin (a natural precursor to testosterone) to restart the body's natural production.

Delivery Complications

• The method of testosterone administration can also lead to side effects. Injectable testosterone can cause abscesses, infection and fluctuation in sexual desire, mood and energy level; testosterone pills and tablets can damage the liver, and testosterone sprays, patches and creams can cause rashes, skin irritation and may enhance male-pattern baldness.