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The Pros and Cons of Testosterone Replacement Therapy
1/30/2019 1:58:08 PM
Fact: The average testosterone level of males has dropped so dramatically that testosterone replacement therapy (TRT) is now over a four billion dollar a year industry. At the current rate of decline of this powerful hormone, by the year 2050 it’s possible that all males globally could become infertile and we could bear witness to the End of Days.
Now that we have your attention, consider that this discussion will not discuss how to use drugs to build bowling ball biceps or knock a full second off your 40-yard dash. It will instead focus on the therapeutic uses of testosterone to help achieve optimal health and, along the way, preserve our species. Let’s start with eight benefits of TRT:
1. Increases muscle mass
2. Helps cardiovascular disease
3. Fights chronic inflammation
4. Helps reduce bodyfat
5. Helps protect against depression
6. Improves mood
7. Improves visual memory, verbal memory, and spatial processing power
8. Eliminates brain fog, leading to clearer thinking
That’s an impressive list of pros, so what are the cons? Once you start taking the drug, are you forced to remain on it for life as your body will completely shut down it’s own production of testosterone? Can it cause ‘roid rage and lead us down a path of violent crime? To answer this question, and other concerns about TRT, we turned to Dr. Michael J. Miletic, MD, FAAFRM.
Miletic was a member of the Canadian Olympic team for weightlifting has made the study of TRT his passion, particularly regarding the psychological effects of this drug. From Dr. Miletic’s perspective, it’s not so much that there are cons to TRT, but more myths and misconceptions.
For starters, Miletic believes that testosterone has been unjustly demonized, being associated with weakness and thus shaming the men who use it. Adding to such “myth-conceptions” are those who have abused the drug for aesthetic purposes or to improve physical performance at the expense of their health. The media jumps on stories about professional bodybuilders and other athletes who have suffered long-term health issues from such over-indulgence, even to the point of early death. Such negative exposure has created a tainted view of hormone replacement therapy, and many men who could benefit from TRT have shied away from using it. This, says Miletic, represents a major health crisis.
 “If someone in middle age has shut down their testosterone production, they need TRT for their brain to function optimally, they need it to maintain their heart and cardiovascular system, and they need it to maintain their bone integrity,” says Miletic. On a broader scale, Miletic would like to see us get away from “sick care” that focuses on waiting until someone is seriously ill before getting medical treatment. Instead, he would like to see his profession take a proactive, holistic approach that, in some cases, could involve TRT.
One reason many men have refused TRT is that they believe it is a lifelong commitment—indeed, there many athletes who claim that after getting off of steroids, their testosterone production never returned to normal. Miletic’s response is that if TRT is properly managed, some individuals may eventually be able to stop taking the drug and still maintain normal testosterone levels. “But the question is not is if it’s possible to get off of TRT, but can our bodies keep up with the demands of our brains and other systems that require testosterone to function optimally? If it can’t, then they should be on it for life.”
One area of research on TRT that Miletic is especially interested in is the field of mind-body medicine. “We can’t be separating the mind from the body when we look at health care. In fact, I can go one step further and say that the mind and the brain depends on a healthy body to properly function and keep functioning cognitively. For example, you hear about people forgetting names and having memory issues, calling it a ‘senior moment” in that they are forgetting things because of their age – it’s not. It’s because of your hormones can affect memory. TRT, as a result, has tremendous implications for the potential to avoid any chronic neurological condition.”
Specifically regarding Alzheimer’s, Miletic says there is a strong relationship between low testosterone and insulin intolerance, and a powerful connection between insulin intolerance and obesity. “There are some Alzheimer’s researchers who are calling Alzheimer’s Type 3 Diabetes. So if we start off people early enough with TRT, even if you have a predisposition to Alzheimer's you may be able to stop it from expressing itself.”
Regarding natural methods of affecting testosterone, Miletic says it’s true that the type of exercise you do can positively or negatively affects testosterone levels. Whereas a weight training program can boost testosterone, Miletic says “about 10 percent max,” an excessive amount of aerobic training can reduce it. However, Miletic says you should not look at exercise in isolation. “If you also manage stress, get an optimal amount of sleep, and eat a healthy diet, then you’re looking at a 50-60 percent improvement -- and maybe more over time if you can adhere to that lifestyle. You can’t just change one variable.” As for those testosterone-boasting supplements that are endorsed by sports celebrities, Miletic says you shouldn’t waste your money.
In addition to taking care of yourself and seeking out health care professionals involved with lifestyle medicine, Miletic says it’s especially important to reduce our exposure to environmental toxins. “Look at how fast the toxins in our world are multiplying. Everybody makes a big deal about removing BPA from plastics, but you have 138 other toxins that are carcinogenic and estrogenic in plastic that are seeping out – how many water bottles are we using each year? And that’s just one example. You also have air quality concerns, such that in some cities kids can’t go outside for recess. You’ve got all kinds of chemical around the house, and you’ve got EPA reducing regulations on these products. We’re bombarded with chemicals at every place we look, and this can be seen in boys who are getting disruptive development and our girls who are getting accelerated development.
Asked how to determine who is a good TRT doctor, Miletic replied, “If a doctor is just writing a simple script for testosterone, I would question the depth of their knowledge, treating low testosterone as if it’s an illness.  Seek out doctors who look at overall health and use a multi-system approach. It’s going to cost you more money to work with someone who takes such a holistic approach, but you’re going to live longer, be healthier, be happier, be smarter, have better sex, and be able to do all the things you want to do.
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