Welcome to Live Well Be Well, a show to help high performers improve their health and well-being.

So let's talk about TRT because I think this is something that's been spoken about a lot online.

When should people look at this as a treatment and when should they not look at this as a treatment?

What's the risk versus the benefits of TRT therapy?

Sure.

I think one of the one of the problems is about TRT is the concept.

It is used more and more recreationally.

Now historically.

And I think probably one of the negative factors about science is that we now know that testosterone has less harmful effects than what it used to in terms of exogenous or testosterone.

It's given either in injections or in the form of gels.

I mean, we used to talk about the risk of prostate cancer, for example, where we now believe that it doesn't cause prostate cancer per SE.

OK, So given it doesn't cause prostate cancer if you don't have prostate cancer.

The other thing about it is that there used to be this issue of cardiovascular disease, a higher risk of cardiovascular disease.

Oddly, with testosterone taking, exogenous testosterone, we now believe from studies done that it doesn't.

So it's become more and more acceptable that it's a safe treatment, especially now with more data emerging.

We talked about metabolic syndrome and low testosterone association with longevity as well.

So if we look at testosterone replacement therapy itself, there are various forms, but in which patients are indicated.

Well, I think that's if patients are symptomatic that we talked about earlier and have truly biochemical evidence of low testosterone.

The group of patients we talked about, if your, if your total testosterone is normal above 12, you don't need testosterone placement therapy.

Because there's also this concept, isn't it, that people sell and say my testosterone could have been 20 odd when I was, when I was in my 20s, It's now 12.

That's halved.

So therefore I need it.

That's not correct.

I mean, ultimately it's about these thresholds and these values have been studies that have done that show what these thresholds mean in terms of symptoms.

So testosterone there, there are two different types.

You've got to go back to basics, two different types of hypogonalism or low testosterone.

1 is secondary, which can include late onset, which is late onset is the commonest 1, so-called male menopause if we talk about that.

So if once you fall below the age of 50, certainly testosterone levels fall and can fall significantly.

The, the other group is the primary hypogonalism.

So men who have an intrinsic problem with their testicles that might have had chemotherapy, radiotherapy, surgery, twists of the testicle, cancers of the testicle where there's primarily a, a problem with the function of the testicle.

So there's two different times you've got to differentiate that.

So it's important to see a clinician and differentiate that rather than just starting testosterone placement therapy.

You want to know why is my testosterone low?

And also screen you for other types of problems like we talked about dyslipidemias, we talked about pre diabetes or type 2 diabetes that can occur as well.

So it's also important to to look at all of that as well as lifestyle.

So the type of patient that you would treat or treat patients genuinely biochemically with low testosterone who after you've gone through a comprehensive testing and trying to differentiate the two different types.

So those patients who have generally low testosterone with symptoms and those are usually in clinical practice, the late onset group of patients, in other words, the so-called male andropause or menopause as well.

TRT generally is is safe.

There are some contraindications, for example, active prostate cancer, for example, patients who have breast cancer, which is very rare, patients who may have too much thickened blood, so-called polycythemia as well and patients who may have heart failure as well.

But generally speaking, it's a safe drug, which therefore means that one of the problems, of course, is is often used as a recreational type of drug, that kind of image, social perception and concept of men, you know, who are muscular and strong.

And that's the image that people want.

That's more of a societal perception and more the problem in terms of the media in portraying what is a male, an ideal male.

And I think that's kind of one of the problems that we face because we've got to remember, as you just said, that testosterone itself can have have a negative impact on your sperm exhaustion.

Although we need testosterone, paradoxically intratesticular testosterone for your sperm production.

Testosterone itself exogenous inhibits the brain hormones called FSH, which drives sperm production.

So it suppresses it.

So therefore it acts like a male contraceptive.

So this concept of taking it now and that's kind of emerged and over many years, but we still don't fully, you know, understand the full cycle of that.

And there are also various other types of treatment people have tried, of course, which we can talk about.

So I think anyone who is hasn't had a child yet or is looking for facility, it's really not a good idea to be doing TRT.

No.

And although it's reversible in the vast majority, but in some patients it's not reversible.

Androgen abuse as we call it.

And certain patients don't recover their their axis.

There are other drugs that people can use.

Generally patients who have hypogonism or low testosterone, you can give things such off label treatments which should be prescribed by a specialist I add as well.

But often on actually, and this is kind of the gym environment, drugs such as Clomid or HCG which act differently.

They boost your endogenous or your own body's testosterone rather than relying on an exogenous form.

But exactly what you just said is that if you're thinking of having children, you shouldn't really be starting TRT or considering TRT.

The thing I found really interesting when I was looking at testosterone levels in men is that testosterone levels seem to drop after men have children.

And I saw a study that said member the highest levels of testosterone were more likely to become committed partners and fathers, at which point they showed steeper drops in their testosterone than did their single childless counterparts.

I found that quite interesting.

I haven't seen that study, but my comment would be that if you're in a relationship and it's good relationship, invariably it's probably going to be a long term relationship.

And where I'm coming to is that if you've had kids, invariably you've been in that relationship for a while.

So therefore you're going to be older.

So therefore, is it just an age dependent factor that testosterone drops as we know as you get older.

So if you think you're going to have kids, if you, if we're having kids in our 30s, you might have a 10 year old, an 8 year old, you're going to be in your 40s and testosterone might be dropping.

That's the way I would look at.

It that's really interesting because I was thinking, is the body saying no more children?

It could be biologically, you know, it could be we don't know enough, do we, about it.

Why do women, you know, in terms of their ovarian reserve by 40 become it's very difficult, isn't it?

Why is that what you know, is it a why?

Why should it switch off?

I mean, that's, that's really kind of an evolutionary discussion, isn't it?

Yeah.

I mean, that's one question that I but.

It's an interesting concept because you don't look at it in men, do we?

So.

We don't look at it in men.

I think everything around children and fertility is always anchored towards women and men just seem to, I think not.

It's just not conceptually spoken about at all.

But I do think it is becoming now.

I think men are becoming so much more aware of their health and becoming much more conscious of their health.

And as you said, I think, you know, looking back at the 1970s, people weren't having children later.

And so now we are, we're wanting to try and become more acutely aware of things that we can actively do that are, but as you said, also living in an environment that is has so many more endocrine disruptors around us.

Thanks so much for listening to hear the full episode.

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