Testosterone replacement therapy (TRT) has been surrounded by conflicting information for years. Some concerns come from older research, while others come from confusing medically prescribed testosterone with anabolic steroid misuse. Here is what current evidence tells us about some of the most common TRT myths.
Myth: TRT Is Only for Older Men
Fact: Testosterone deficiency is not defined by age. Men can develop hypogonadism at different stages of adulthood because of conditions affecting the testes, pituitary gland, or hypothalamus, as well as certain medications, obesity, and other medical conditions. Diagnosis is based on appropriate symptoms and consistently low testosterone levels, not age alone. (link: Endocrine Society)
Myth: TRT Causes Prostate Cancer
Fact: Current evidence has not established that appropriately prescribed TRT causes prostate cancer. In a large randomized trial involving more than 5,000 men with hypogonadism who were carefully screened for prostate cancer risk, the incidence of high-grade or any prostate cancer was low and did not differ significantly between men receiving testosterone and those receiving placebo.
That does not mean prostate risk can be ignored. Long-term prostate safety remains an area of ongoing study, and appropriate prostate risk assessment and monitoring remain part of testosterone treatment.
Myth: Once You Start TRT, You Can Never Stop
Fact: TRT does not create a biological requirement that you remain on treatment forever. However, external testosterone suppresses the body's own hormonal signaling while you are taking it. If treatment is stopped, endogenous testosterone production may take time to recover, and the symptoms that originally led to treatment may return if the underlying cause of low testosterone remains.
How completely and how quickly natural testosterone production recovers varies among individuals. Decisions about stopping or changing treatment should therefore be made with your provider rather than by changing your dose or schedule on your own.