Derek Illman of London, Ont., is a fitness fanatic and a self-proclaimed “podcast junkie.”
Through conversations at the gym and while listening to podcasters, the 55-year-old learned about testosterone replacement therapy (TRT) and its potential in boosting energy and strength.
“I thought, ‘If TRT can help me get some minor improvements in performance at the gym, will that translate to longevity?'” said Illman.
“It makes sense to me in my non-medical mind that improved performance at the gym should translate potentially into a healthier day-to-day feeling or ideally, better aging.”
I think in a properly assessed individual, testosterone can be a wonderful treatment that’s very effective.– Dr. Gerald Brock
Illman said his gym friend told him it was easy to purchase TRT online, but Illman wanted to go through a trusted family doctor instead. After being assessed, he started on a low dose of TRT gel in December to improve low testosterone.
But while Illman was prescribed the therapy, a London urologist says some men are taking it without meeting the criteria, which can come with risks.
“My concern is that many of these men don’t have low testosterone, and if they’re not properly assessed, they may just be prescribed the medication without really needing it,” said Dr. Gerald Brock, former president of both the Canadian Urology Association and International Society for Sexual Medicine.
“I think often they go online, they look at the symptoms and they think that they have many of the symptoms that are outlined.”
A study from the Amercian Urological Foundation found a quarter of men do not get their testosterone tested before starting TRT and about half who have begun the treatment don’t get their levels tested afterwards.
There are valid medical reasons to be on TRT under the guidance of a doctor, said Brock. However, he added, about half of his patients interested in starting TRT have not been tested by a medical professional for low testosterone, and have instead picked it up through websites, friends or sellers at gyms.
“That’s a real problem because if you’re taking any medication and it’s not for the right reason, then you’re not going to derive the benefits and you may be exposed to some of the harms,” Brock said, adding a doctor will do blood tests and assess symptoms before prescribing TRT.
Ontario Today46:36What’s been your experience with testosterone replacement therapy?
We hear your stories about taking testosterone — on and off label — and hear from an expert in men’s health, Dr. Gerald Brock.
Risks of being on the therapy may include blood thickening, which can cause a stroke or heart attack, fertility issues and cardiovascular problems, Brock said — and these issues can be amplified when people take the wrong dosage or don’t monitor possible side-effects with a doctor.
Some of those side-effects may also include fatigue, decreased muscle mass and reduced sexual function.
Online ‘manosphere’ popularizing TRT
Low testosterone is not an increasing problem, said Brock, but there is more awareness of the issue and access to TRT, especially among younger men.
Chatter around TRT could be connected to an online “manosphere” movement, said Christian Ylagan, who teaches a course about masculinity at Western University.
Manosphere refers to an online subculture of men expressing dissatisfaction with a perceived loss of masculinity and opposing feminism, Ylagan explained. He said the subculture often conforms to conventional forms of masculinity, where men are expected to be dominant, muscular and sexually active.
“The use of hormone therapy, in my mind, is really tied to reinforcing some of the ideas of masculinity that we have,” Ylagan said.
Economic success has also been a traditional marker of masculinity, Ylagan said. But as that becomes more difficult for young men to achieve, many are turning to physical augmentation, he added.
“There’s this narrative that if you just work on your body or achieve certain things, then you’ll be considered an ideal man, but what does that even really mean?”
Weighing benefits and risks
Illman said he stopped the TRT gel after three months because he noticed a change in his mood — he became more irritable while driving, working and grocery shopping.
“I was noticeably short tempered and my patience was lacking,” he said. “I just thought this irritability is not a good personality trait that I want to perpetuate.”
Brock said mood changes are a relatively uncommon side-effect.
While TRT is not for everyone, the doctor said, it can be a good match for men who meet the criteria for low testosterone.
“I think in a properly assessed individual, testosterone can be a wonderful treatment that’s very effective,” he said. “From my perspective, if they’re evaluated properly and they understand the risks, the benefits often outweigh the risks.”
Now off TRT for a month, Illman said his mood has returned to normal, but he’s also again experiencing reduced strength and endurance at the gym.
He said he would consider going back on the therapy in the future, but is happy to be on a break for now.
