Is there a safe version of testosterone replacement therapy?
Introduction
Testosterone replacement therapy, or TRT, is a widely used hormone therapy used to address abnormally low levels of testosterone, or hypogonadism. Available in a variety of forms, including patches, gels, or injections, TRT treatment may improve low testosterone symptoms like low sex drive and decreased energy, but often at the cost of potential health issues like infertility, testicular shrinkage, and sleep apnea.
Find out why people choose testosterone treatment, what other risks are involved, and why some people choose to explore TRT alternatives like enclomiphene citrate.
Key takeaways:
TRT, a widely used hormone therapy, is used to address abnormally low levels of testosterone and reduce symptoms like low sex drive, erectile dysfunction, decreased muscle mass, and fatigue.
While TRT shuts down the body’s natural production of testosterone and replaces it with synthetic testosterone, TRT alternatives like clomiphene citrate, Clomid, and enclomiphene citrate restore your body’s testosterone production.
Clomid consists of two isomers: zuclomiphene and enclomiphene citrate, an estrogen agonist and estrogen antagonist, and stays in the body much longer than enclomiphene on its own.
Enclomiphene citrate is a more fertility-friendly alternative to TRT that boosts testosterone without testicular shrinkage or infertility.
What is TRT?
TRT is a hormone treatment for low testosterone, or hypogonadism. It has been used since 1935 to reduce symptoms like low sex drive, erectile dysfunction, decreased muscle mass, and fatigue, which are all associated with low testosterone. Using injections, pellets, patches, or gels, TRT shuts down the body’s natural production of testosterone and replaces it with a synthetic version of the hormone.
Some people use TRT because their levels are abnormally low and some people use it for non-medical reasons like increasing their energy levels and losing weight. In recent years, the use of TRT has increased four-fold in men aged 18-45 years and three-fold in older men, partly due to the rise of telemedicine.
Benefits of TRT
When your body isn’t making enough testosterone, TRT attempts to pick up the slack using synthetic testosterone. In a person with hypogonadism, this hormone treatment can result in:
Improved sexual function: In this study of hypogonadal patients experiencing erectile dysfunction, taking topical testosterone gel for 12 months resulted in a “significant” improvement in sexual function due to synthetically increased testosterone levels. And in a 2016 double-blind study comparing TRT to placebo, those who received TRT for one year saw improvements in sexual function, including activity, desire, and erectile function.
Increased energy: A study of 105 patients taking prescription testosterone found that 52.3% of men reported having improved energy and 41.9% of men said the treatment improved their libido.
Weight loss: Studies show that TRT improves body composition by decreasing fat mass and increasing lean body mass.
More muscle mass: Studies also show that TRT supports muscle growth by increasing muscle protein synthesis.
Improved athletic endurance: Some professional athletes use TRT to level up as the hormone is associated with increased physical performance such as more speed and better endurance.
Risks of TRT
Despite the reported benefits of TRT, many experts say that the risks are too great, ranging from reduced sperm production to testicular shrinkage, and more. The risks associated with TRT include:
Low sperm count: TRT isn’t always the best option for men who want to preserve their fertility. The hormone treatment is known to negatively impact spermatogenesis by inhibiting the production of follicle stimulating hormone and luteinizing hormone.
Testicular shrinkage: In a study of men aged 38 to 81 undergoing TRT, testicular volume decreased over time, from a mean of 16.5 ml before treatment to 13.7 ml at 24 months, with atrophy becoming significant from 6 months. These effects were more likely to occur in patients with larger baseline testicular size or those treated with injectable formulations.
Enlarged prostate: Testosterone supplementation has been shown to increase prostate size by 12%, which may increase prostate cancer risk.
Cardiovascular issues: Both the American College of Cardiology (ACC) and American Endocrine Society agree that TRT should be avoided by those with poorly controlled heart failure (HF), recent myocardial infarction (MI), revascularization, and stroke within last six months because of an increased risk of heart attack.
Sleep apnea: TRT may worsen sleep apnea due to neuromuscular changes to the airways, changes in metabolic requirements, and changes in the physiologic response to hypoxia and hypercapnia.
Acne: TRT may also trigger acne or other skin conditions by boosting the production of sebum, an oily substance in the skin.
Blood clots: The Mayo Clinic reports that TRT is also associated with an increase in red blood cell production, which may lead to blood clots.
What causes low testosterone?
Testosterone declines naturally with age, but there are a number of other contributing factors. These include:
Age: Beginning around age 30 to 40, testosterone levels may start to slowly decrease naturally.
Medication: Some medication or treatments, like chemotherapy, can impair testosterone production.
Congenital conditions: These include the absence of testicles at birth, undescended testicles, an underdevelopment of Leydig cells in the testicles, or Klinefelter’s syndrome.
Other testicular issues: Testicle injuries, inflammation, and certain tumors can negatively affect testosterone production.
Endocrine disorders: Conditions that affect how your hypothalamus and/or pituitary gland function may also lead to low testosterone, such as Kallmann syndrome or Prader-Willi syndrome.
Obesity: Research shows that moderate obesity decreases testosterone due to insulin resistance-associated reductions in sex hormone binding globulin.
Heavy alcohol use: Studies have found that heavy alcohol consumption results in reduced testosterone levels in the blood and may also impair the function of the testicular Sertoli cells related to sperm production.
TRT alternatives
Testosterone replacement therapy is not the only option when it comes to increasing your testosterone levels. Whether you have hypogonadism or you’re simply looking to optimize your testosterone production, TRT alternatives can help you achieve this safely without using synthetic testosterone. Two types of TRT alternatives available are clomiphene citrate and enclomiphene citrate.
Clomiphene citrate
Clomiphene citrate, better known as Clomid, has been around since 1967 as a fertility treatment for women. It is also used off-label to increase testosterone. Consisting of two isomers, 38% zuclomiphene and 62% enclomiphene, Clomid has been heralded as “safe and effective with few side effects” when used as long-term treatment of hypogonadism and is called an “effective and safe alternative to testosterone supplementation.”
However, the ingredient zuclomiphene has been shown to increase estrogen and stay in your system a long time, accumulating much more over time than enclomiphene. Clomid is also associated with a number of side effects such as mood swings, depressed mood, irritability, anxiety, enlarged breasts, and libido issues.
Enclomiphene citrate
It is possible to derive the benefits of Clomid without the downsides of zuclomiphene. Enclomiphene, when taken on its own, works drastically differently than zuclomiphene by blocking estrogen, thereby increasing levels of LH and FSH and boosting testosterone production by 1.5-2.5X. And unlike TRT, which decreases testicular size and replaces testosterone synthetically, enclomiphene stimulates the testes (and increases size) to restore the body’s natural production of testosterone.
Studies have shown that enclomiphene treatment has resulted in an increase of ~5 lb. of lean body mass in as little as 12 weeks and in a study that compared enclomiphene citrate to topical testosterone, researchers found that while both testosterone treatments increased testosterone, enclomiphene did not affect sperm production like TRT.
Enclomiphene is generally well tolerated with minimal side effects occurring rarely, such as headache (in less than 4% of patients), nausea (less than 3%), and joint pain (less than 2%).
How to safely transition from TRT to an alternative
Many people are afraid to stop taking TRT because their testosterone levels will drop. But switching to a TRT alternative like enclomiphene can help restore testosterone levels without the side effects and risks associated with TRT. However, doctors report that it takes around 3 to 9 months for spermatogenesis to return after transitioning men to a TRT alternative, so patience is key. If you are hoping to come off TRT, it’s important that you do so gradually and under a doctor's care. They will typically recommend tapering off over time to avoid shocking your system.
Other safe ways to increase testosterone
There are other ways to optimize your testosterone naturally and work well in combination with a medication like enclomiphene. These include:
Following a nutritious diet comprised of macronutrients like proteins, healthy fats, and carbohydrates, and micronutrients like potassium, magnesium, and zinc
Exercising regularly combining strength and high-intensity training
Getting adequate sleep by setting and maintaining a regular bedtime and aiming for 7-9 hours of sleep per night
Cutting back on alcohol and stop smoking
Reducing your stress levels
Limiting exposure to endocrine disruptors like BPA and plastics
Signs you have low testosterone
Not sure you can benefit from taking a medication like enclomiphene? Some common signs you have low testosterone include:
Decreased libido
Erectile dysfunction
Low sperm count
Insomnia
Decrease in muscle size and strength
Bone loss
Hair loss
Increase in body fat
Depression
Difficulty concentrating
Poor memory
Fatigue
But you don’t have to have low testosterone to benefit from the Maximus Testosterone Protocol, which combines enclomiphene tablets with CLIA-certified lab testing, allowing you and your doctor to monitor your testosterone levels before and after starting treatment. Without shutting down your testicles or hindering your sperm production, you’ll see results like increased energy, more lean mass, greater sexual function, and even more motivation along with live coaching and community support to keep you on track.
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