Myth Busting, Testosterone Edition
Bridget Hagen, DNP, APRN, FNP-C

Testosterone has gotten a bad rap because of its abuse in the athletic communities. Like many things though, there is a wide chasm between use and abuse. The Drug Enforcement Administration (DEA) cites that abusers of testosterone are using doses 10-100x that of a normally prescribed dose.[1] Using testosterone at such doses inevitably increases the side effect profile in the same way that using something like the over-the-counter drug Tylenol at 10x the recommended dose would likely cause liver failure. Additionally, abusers often engage in stacking (using multiple types of steroids at the same time), cycling (taking them for a period of time and then abruptly stopping), and pyramiding (engaging in those two practices simultaneously), each of which also independently increases risk. Additionally, most are sourcing their medications from underground markets with no regulations regarding purity, potency, etc. [2][3]  rather than medical professionals. Because of these and other factors, many myths about testosterone have originated. Let’s address some of the most common here.

Testosterone is going to make me overly muscular. Testosterone will help you decrease fat and increase muscle mass[4]; however, no typically prescribed dose of hormones alone will put excessive amounts of muscle on anyone. Keep in mind with TRT the levels of testosterone taken are intended to bring one back to an optimal range, not to target supraphysiologic levels.

Testosterone is going to give me “roid rage.” This again stems from communities of abuse who are using exceptionally high doses and often engaging in polypharmacy making it challenging to delineate what the actual cause is.[5] Testosterone at normally prescribed doses is actually linked to improvements in mood, fatigue, and self-esteem, not irritability and aggression.[6]

Testosterone is going to give me prostate cancer. Testosterone’s link to cancer is complicated and unclear. The evidence suggests that if cancer is present testosterone may help expedite its growth but there is insufficient evidence to support that it causes cancer in those who do not already have it. The confusion seems to stem from the fact that androgen (testosterone) deprivation therapy can be an effective treatment for prostate cancer.[7]

Testosterone is only for older men. Testosterone levels begin to decline at age 30 at a rate of approximately 1% per year. [8] If TRT is started at a younger age, men can experience its benefits for an extended amount of time and potentially mitigate many age-related issues like weight gain, muscle loss, decreases in bone density, etc.[9]

Natural supplements can significantly boost testosterone levels. Some nutritional deficiencies (e.g., magnesium, zinc, vitamin D) undoubtedly have an impact on testosterone levels. Absent those conditions though there is no compelling evidence to suggest that supplements meaningfully impact testosterone.[10] A recent study reviewed fifty popular online supplements claiming to “boost T” and found that most had no data to support their claims.[11] More so, many contained supra-therapeutic vitamin doses which alone can have ill effects.[12] Often if it sounds too good to be true, it is.

Sources:

[1] United States Drug Enforcement Administration. (n.d.). Steroids. https://www.dea.gov/factsheets/steroids#:~:text=Anabolic%20steroids%20are%20synthetically%20produced,performance%2C%20and%20improve%20physical%20appearance

[2] National Health Services. (2022). Anabolic steroid misuse.  https://www.nhs.uk/conditions/anabolic-steroid-misuse/

[3] The Washington Post. (n.d.). What bodybuilders do to their bodies and brains. https://www.washingtonpost.com/investigations/interactive/2022/bodybuilding-health-risks/

[4] Bassil, N., Alkaade, S., & Morley, J. E. (2009). The benefits and risks of testosterone replacement therapy: a review. Therapeutics and clinical risk management, 5(3), 427–448. https://doi.org/10.2147/tcrm.s3025

[5] The Washington Post. (n.d.). What bodybuilders do to their bodies and brains. https://www.washingtonpost.com/investigations/interactive/2022/bodybuilding-health-risks/

[6] Connor, D. B., Archer, J., & Wu, F. C. W. (2004). Effects of testosterone on mood, aggression, and behavior in young men: A double-blind, placebo-controlled, cross-over study.  The Journal of Clinical Endocrinology & Metabolism, 89(6), 2837–2845. https://doi.org/10.1210/jc.2003-031354

[7] Lenfant, L., Leon, P., Cancel-Tassin, G., Audouin M., Staerman, F., Rouprêt, M., Cussenot, O. (2020). Testosterone replacement therapy (TRT) and prostate cancer: An updated systematic review with a focus on previous or active localized prostate cancer. Urologic Oncology: Seminars and Original Investigations, 38(8), 661-670. https://doi.org/10.1016/j.urolonc.2020.04.008

[8] Cleveland Clinic. (2023). Why are testosterone levels declining? https://health.clevelandclinic.org/declining-testosterone-levels

[9] Bassil, N., Alkaade, S., & Morley, J. E. (2009). The benefits and risks of testosterone replacement therapy: a review. Therapeutics and clinical risk management, 5(3), 427–448. https://doi.org/10.2147/tcrm.s3025

[10] Zamir, A., Ben-Zeev, T., & Hoffman, J. R. (2021). Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations. Nutrients, 13(10).  https://doi.org/10.3390/nu13103375

[11] Clemesha C.G., Thaker H.,& Samplaski M.K. (2020). ‘Testosterone Boosting’ Supplements Composition and Claims Are not Supported by the Academic Literature. World Journal of Men’s Health. (1), 115-122. doi: 10.5534/wjmh.190043. Epub 2019 Jun 14. PMID: 31385468; PMCID: PMC6920068.

[12] Ibid.