Dr. Perito: Setting the Record Straight About Testosterone Replacement Therapy

By Dr. Paul Perito, MD FACS | Founder of the UroFill® Clinic and Perito Urology

As an expert in men’s health specializing in andrology and urology, I’ve seen far too much disinformation about testosterone replacement therapy. This especially comes in the wake of the so-called “looks-maxxing” and “T-maxxing” movements. There are a few key points that are important to address, and a few myths I’d like to dispel.

Testosterone Therapy is Not Just About Male Vanity

Yes, in the era of “manosphere” podcasts and general skepticism about established medical practices, it’s easy to lump testosterone therapy in with human growth hormone (HGH), anabolic steroids, etc. Just because it’s easy doesn’t mean it’s accurate. 

Men’s testosterone levels decrease as they age, typically once they hit their late 30s / early 40s. With this decline comes a host of negative side effects, including brain fog, irritability, decreased libido, and higher body fat. The first three can lead to psychological and interpersonal issues, the fourth increases the likelihood of an earlier death.

Testosterone therapy, when overseen and guided by a qualified andrologist, can abate these issues and lead to a higher overall quality of life. It also leads to increased bone density and helps metabolic issues such as insulin sensitivity. These benefits are all well-established and backed up by years of medical research.

Carefully monitoring your hormone levels and adjusting them as needed isn’t just about trying to look good without a shirt on; it’s about maintaining a level of physical and mental health that can keep you and/or the men in your life from the pitfalls of old age.

The Goal of TRT is Not to “Kill Your Sperm”

A common side effect of testosterone replacement therapy is a significantly lower sperm count. I wouldn’t recommend TRT to anyone trying to have children, and there are other options to maintain healthy testosterone levels without the risk of fertility issues. Any qualified andrologist or medical provider would tell their patients this.

Male sperm counts have also dropped by 50% over the last fifty years for reasons we’re just beginning to understand. TRT isn’t and hasn’t been treated on anywhere near enough of a scale to be a primary or secondary factor; it’s more likely that environmental exposure, and increasingly sedentary lifestyles are the main culprits. Pointing to testosterone therapy as the proverbial boogeyman in the closet is inaccurate and irresponsible. Despite this, many columnists (who aren’t medical experts) continue to push this narrative.

You Can’t and Shouldn’t Self-Diagnose Low Testosterone Levels or Refer to Online Services

There’s an unfortunate gray market for healthcare where unqualified providers make spurious claims with often detrimental results for patients. The appeal is understandable; the cost of health insurance keeps rising, and booking medical appointments can be time-consuming. What if, instead of navigating the bureaucracy of our healthcare system, you could just fill out a form on a website or app and get the near-immediate gratification of a diagnosis and treatment to your liking?

The reality is that qualified medical professionals aren’t there to simply go along and sign off on your self-diagnosis; they’re there to provide objective, well-informed treatments based on the evidence at hand. They require regular check-ups and testing to monitor the results of any treatments, TRT or otherwise, to make sure that it’s right for the patient.

It’s also the responsibility of qualified medical professionals and referring pharmacies to ensure the quality, safety, and efficacy of any prescriptions. Many of the online services that offer testosterone, GLP-1, ED medications and so on will mail “compounded” solutions that are a mish-mash of different chemicals. These compounds can be inconsistent, vary wildly in their composition, and lead to other side effects that are difficult to treat and diagnose. 

In Summary

Testosterone replacement therapy isn’t for everyone. If you’re a man in your 20s looking for a more chiseled physique, try hitting the gym more often, cut down on alcohol and junk food, and make sure you’re getting a good night’s sleep. 

If you’re a man in his 40s or older, get your testosterone checked as part of your annual checkup with an actual doctor and see a specialist if you’re concerned about general sluggishness, low libido, and decrease in muscle mass. In either case, try not to fall prey to either the columnists and reporters who stigmatize and dismiss testosterone therapy as a viable treatment, or to the snake oil salespeople who treat it as a cure-all that can be prescribed sight unseen. Your health is unique to you, and it needs to be analyzed and diagnosed by someone with the proper training and qualifications to help you understand your options.