Safety Profile of TRT

Why Understanding TRT is Essential to Your Health Journey

Testosterone Replacement Therapy (TRT) is a game changing option for men experiencing the effects of low testosterone (Low T), particularly those aged 40 upwards. With benefits ranging from enhanced energy to improved muscle tone and mood, TRT can make a big difference to the quality of your life. However, as with any medical treatment, understanding both it’s potential benefits and risks is essential for informed decision-making.

At Omniya Clinic London, we’re committed to guiding you through this journey with clear, research-based information. Let’s break down the potential risks, safety considerations, and side effects of TRT, so you can feel confident in your decision-making process.

What Are the Risks of Testosterone Replacement Therapy?

Although TRT is generally considered safe when administered and monitored by qualified professionals, certain risks are associated with the treatment. These risks are often tied to individual health factors and require careful assessment and management.

1. Cardiovascular Risks

One of the most discussed concerns with TRT is it’s potential impact on heart health. Studies presented mixed findings in this area until early 2024 when the large multi-centre double blinded placebo-controlled randomised study known as TRAVERSE provided compelling evidence to say that patients on TRT are not at an increased risk of cardiovascular events compared to the general public(1). There is an excellent review article written subsequently by Professor Hackett titled “Long Term Cardiovascular Safety of Testosterone Therapy: A Review of the TRAVERSE Study”, which summarises the findings of what is considered one of the largest and most robust studies on the risks and benefits of TRT(2).

At Omniya Clinic, we usethorough pre-treatment assessments to determine each patient’s cardiovascular health, ensuring TRT is safe for those with or without pre-existing heart conditions.

2. Prostate Health Considerations

The relationship between testosterone therapy and prostate health has been a subject of research for decades. Historically, some doctors avoided TRT due to concerns that it could accelerate prostate cancer growth. However, according to the Endocrine Society’s clinical guidelines(3), recent data does not support a direct link between TRT and an increased risk of prostate cancer in otherwise healthy men. Nonetheless, the guidelines recommend regular prostate monitoring for those undergoing TRT. In line with this recommendation, our team at Omniya follows a careful monitoring protocol to safeguard prostate health.

3. Sleep Apnoea

TRT can potentially worsen sleep apnea, a condition that disrupts breathing during sleep, particularly in men who are overweight. Longterm risks of untreated sleep apnoea include heart attacks and strokes. Research published in the Journal of Clinical Endocrinology highlights that testosterone may play a role in increasing airway resistance, which can exacerbate sleep apnoea symptoms(4). Importantly, one of the common presenting symptoms of a patient with low testosterone is difficulty losing weight and weight gain; this is also one of the commonest causes of sleep apnoea. TRT encourages weight loss and muscle gain and therefore can be helpful in the reversal of obstructive sleep apnoea. At Omniya, our initial assessments include a thorough examination of any pre-existing sleep disorders, helping us identify individuals at risk and adjust treatments as needed. It is important if we feel someone may have sleep apnoea that this is explored and investigated (and treated if required) first, before starting TRT.

For more information, please see our page on TRT and Sleep Apnoea.

4. Fertility Considerations

By supplementing testosterone, the body may reduce its own production of the hormone, which can lead to lower sperm production. This is an essential consideration for men planning to start or expand their families. To mitigate this risk, adjunctive treatments like human chorionic gonadotropin (HCG) can sometimes be used alongside TRT. Studies have found that HCG therapy could help maintain sperm production in men receiving testosterone therapy, however more research is needed in this area, particularly around the longterm use of HCG to maintain fertility(5). 

Safety Measures at Omniya Clinic

Patient safety is at the heart of our TRT program at Omniya Clinic. Here’s how we ensure that every treatment is safe, effective, and personalised:

1. Comprehensive Initial Assessment: Each patient begins with a full health evaluation, including blood tests, cardiovascular assessment, and physical examination, following guidelines set by the Endocrine Society.
2. Personalised Treatment Plans: We tailor each TRT regimen to the specific needs and health profile of the patient. Our goal is to achieve optimal hormone levels without compromising overall health.
3. Regular Monitoring: From blood work to prostate exams, our team schedules regular follow-up appointments to track your testosterone levels and general health throughout your treatment. This approach is in line with the National Institute for Health and Care Excellence (NICE) recommendations, ensuring that your treatment remains balanced and safe.
4. Ongoing Education: TRT is a rapidly evolving field, and our team stays updated on the latest research. We share new findings with our patients, including relevant studies like the TRAVERSE study (1) to keep you informed and empowered.

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Common Side Effects of Testosterone Replacement Therapy

Just as with any medical treatment, TRT may have side effects. However, most side effects are mild and manageable. Here are some that you may encounter:

• Acne or Oily Skin: Testosterone can increase oil production in the skin, leading to mild acne in some men. Optimisation of your hormone levels, appropriate skincare and sometimes medication to treat acne are some of the ways that our specialists will manage this problem.
• Fluid Retention: Some men experience mild fluid retention, especially in the early stages of treatment where it will often resolve after the first few weeks.
• Increased Red Blood Cell Count: Testosterone can elevate red blood cell levels, which may lead to a risk of blood clots. Regular blood tests can help monitor and manage this.
• Breast Tenderness or Enlargement: Known as gynaecomastia, this side effect is relatively rare and often resolves with dose adjustments. Your doctor will advise you on what to look out for so as to prevent this.
• Changes in Cholesterol Levels: TRT can affect cholesterol, requiring periodic blood tests to monitor cholesterol levels. A healthy diet and lifestyle can help mitigate this effect.

The good news is that many of these side effects are manageable with lifestyle adjustments or changes to your treatment plan. At Omniya Clinic, our team is on hand to provide guidance and support every step of the way.

Long-Term Considerations: What Does the Research Say?

The long-term impact of TRT is a growing area of research. While early studies raised questions, more recent findings are uncovering the potential for long-term benefits, particularly in areas like bone health, cognitive function, and metabolic health.

• Bone Density: Higher testosterone levels are linked to increased bone density, potentially lowering the risk of osteoporosis in older men. Research shows not only low oestrogen levels predispose individuals to osteoporosis, but also low testosterone levels do. The same research found that being on TRT and normalising testosterone levels can remineralise the bone and reduce the risks of osteoporosis(6).
• Cognitive Function: Studies suggest that testosterone may play a role in cognitive health. A study published in 2020 found that men with higher testosterone levels had improved cognitive performance, particularly in areas like memory and concentration(7).
• Diabetes Management: For men with type 2 diabetes, TRT may offer additional metabolic benefits. More and more research is finding that TRT can improve insulin sensitivity, potentially supporting better blood sugar management and reducing the risks of diabetes complications(8).

Making an Informed Decision

Choosing TRT is a highly personal decision that involves weighing the potential benefits and risks. At Omniya, we encourage all prospective patients to have open discussions with our specialists, exploring their symptoms, goals, and any questions they may have. Here are some practical steps to consider when thinking about TRT:

• Discuss Symptoms and Concerns: Be open about the symptoms you’re experiencing and how they impact your quality of life.
• Ask About Risks and Benefits: Our specialists can provide detailed information on the expected outcomes and any potential side effects.
• Consider Long-Term Health Goals: TRT can support a range of health goals, from physical performance to cognitive health.
• Evaluate Alternative Options: While TRT is effective, it may not be suitable for everyone. Our team is here to explore alternative approaches if needed.

We believe that knowledge is power. Our mission at Omniya Clinic is to provide every patient with the guidance they need to make informed decisions about their health and well-being.

Schedule a consultation to discuss TRT options.

The Path to Renewed Vitality Starts Here

Testosterone Replacement Therapy can be a life-changing treatment for men with low testosterone. By understanding its risks, safety considerations, and side effects, you can make an empowered decision that aligns with your health goals. At Omniya Clinic London, our experienced team is committed to delivering safe, effective, and personalised care, helping you achieve optimal health and well-being.

If you’re experiencing symptoms of low testosterone and are considering TRT, take the first step towards renewed energy, confidence, and vitality with Omniya Clinic. Our team of experts is ready to guide you on your journey to better health.

Contact Omniya Clinic today to start your journey with TRT

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**References**

1. 1. Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, et al.; TRAVERSE Study Investigators. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med 2023;389:107-17.
   2. Hackett G. Long Term Cardiovascular Safety of Testosterone Therapy: A Review of the TRAVERSE Study. World J Mens Health. 2024;1-9.
   3. British Society of Sexual Medicine. A practical guide on the assessment and management of testosterone deficiency in adult men. Available at: http://bssm.org.uk/ (Accessed November 2024).
   4. Hoyos C, Killick R, Yee B, Grunstein R, Liu P. Effects of testosterone therapy on sleep and breathing in obese men with severe obstructive sleep apnoea: a randomized placebo-controlled trial. Clinical Endocrinology (2012) 77, 599–607.
   5. Coviello AD, Matsumoto AM, Bremner WJ, Herbst KL, Amory JK, Anawalt BD, Sutton PR, Wright WW, Brown TR, Yan X, Zirkin BR, Jarow JP. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab. 2005 May;90(5):2595-602. doi: 10.1210/jc.2004-0802. Epub 2005 Feb 15. PMID: 15713727.
   6. J Finkelstein, A Klibanski, R Neer, S Greenspan, D Rosenthal, W Crowley. Osteoporosis in Men with Idiopathic Hypogonadotropic Hypogonadism. Annals of Internal Medicine. 1987:106:354-361.
   7. Lisco G, Giagulli V, De Tullio A, De Pergola G, Guastamacchia E and Triggiani V. Age-Related Male Hypogonadism and Cognitive Impairment in the Elderly: Focus on the Effects of Testosterone Replacement Therapy on Cognition. Geriatrics 2020, 5, 76; doi:10.3390/geriatrics5040076.
   8. 6. Si Hyun Kim, Jae Joon Park, Ki Hong Kim, Hee Jo Yang, Youn Soo Jeon, Sung Ryul Shim, Jae Heon Kim. Efficacy of testosterone replacement therapy for treating metabolic disturbances in late‐onset hypogonadism: a systematic review and meta‐analysis. International Urology and Nephrology (2021) 53:1733–1746.