Robert had always been full of life. His energy and optimism seemed boundless and drew people toward him, helping him build strong relationships and a successful career. But as he got a little older, things started to change. “I didn’t know what to do,” he says. “I wasn’t young anymore, but I was far from old. I just didn’t feel like myself. My energy was gone, I got tired quickly, and I had trouble concentrating. It felt like I had lost a part of myself.” Based on his own research, Robert suspected he had found the culprit: low testosterone.
Low testosterone, also known as low T, is a common condition, particularly as you age and begin to experience male menopause. There are also many other reasons men have low T, including obesity, heart issues, illness, and injury. But no matter what the cause and no matter how common the condition, it is never easy. In many real ways, a reduction in testosterone can change who you are.
Robert, like many men, wanted to feel better, but he was also reluctant to seek professional help, particularly when he saw products claiming to help without the need for a prescription. As he explains, “There were pills at my drugstore that promised to raise my testosterone, and I saw countless online ads for testosterone pills. They seemed like tempting alternatives to going to the doctor.”
But are testosterone pills safe? The answer, in most cases, is no. In fact, research suggests they can be actively harmful and create dangerous long-term health conditions. By seeking the guidance of a medical professional who specializes in hormone health, you can ensure that you get the treatment you need to address your symptoms without further compromising your well-being.
The Use of Testosterone Pills in the United States
Testosterone replacement therapy (TRT) is widely recognized as the single best treatment for low testosterone, and prescription testosterone products are successfully used by millions of men across the United States each year. These products include testosterone pellets, patches, and injections. But until recently, there was only a single oral form of TRT available in the US: methyltestosterone (sold under the brand names Android, Metandren, and Testred). The reason for this was simple: these medications have presented serious health risks and unreliable efficacy. As one research cohort wrote in 2015, “Oral formulations of testosterone are not approved in the USA, due to historically being linked with liver toxicity and fluctuations in testosterone levels.” Indeed, even methyltestosterone is seldom used due to these risks.
Liver toxicity and lack of predictable therapeutic effect have not been the only barriers to oral use of testosterone replacement therapy. In 2018, the FDA overwhelmingly voted against approval for Tlando, an oral testosterone undecanoate capsule designed to treat hypogonadism. While testosterone undecanoate sidesteps many of the concerns that arise from other oral forms of TRT by virtue of bypassing the liver, the FDA found that the cardiovascular risks associated with Tlando far outweighed any benefits.
In the spring of 2019, however, the FDA approved an oral testosterone replacement product—Jatenzo—for the first time in over 60 years. While the approval of this testosterone undecanoate capsule was an exciting development, it was not without caveats. In its press release, the FDA emphasized that the drug was only approved for use in men with specific medical conditions like Klinefelter syndrome or pituitary glands damaged by tumors. They also noted “Jatenzo’s effects on raising blood pressure can increase the risks of heart attack, stroke and cardiovascular death [in men with age-related hypogonadism].” Additionally, Jatenzo is a standardized medication, which means it cannot be customized for each patient. This means that even if you are in the broad category of an ideal recipient, it may not be good for you specifically at the dosages in which it is available.
Jatenzo may have practical limitations even for men who are otherwise good candidates for the drug, as it must be taken twice a day with food. “Important to realize is that the treatment is likely to be useful to many men, though it remains unclear how it is going to fit into our choices of treatment. We have yet to see how this works out in regular medical practice,” says Dr. Abraham Morgentaler, Associate Clinical Professor of Urology at Harvard Medical School. “For some men, how well the testosterone levels are sustained may make the difference. Also, a lot of people don’t take their pills, especially when the dose is more than once per day.”
With such complex risk factors and practical considerations limiting the use of testosterone pills in the US, it may be tempting to turn to non-prescription products. However, that can bring even greater dangers.
The Risky Business of Over-the-Counter Testosterone Products
In the United States, testosterone and its close relatives are Schedule III drugs. Other Schedule III drugs include ketamine, anabolic steroids, and buprenorphine. In other words, this category covers serious medications that can only legally be obtained via prescription, and their use should always be closely monitored by a qualified health professional. Due to this classification, over-the-counter testosterone pills sold in legitimate drug stores and health shops do not actually contain any form of testosterone—it would be illegal for them to do so. Rather, they are sold as “testosterone boosters”—products that ostensibly encourage testosterone production rather than introduce exogenous testosterone.
While there is some research indicating that certain ingredients used in these products may have some positive effect, no over-the-counter testosterone treatment has been shown to improve testosterone levels by more than 20%—and many are not supported by any evidence at all. Additionally, these supplements may present a plethora of health risks both due to the known effects of specific ingredients and the lack of regulation within the supplement industry as a whole.
Of course, it is possible to find pills that contain actual testosterone, usually online. However, these are not sold by reputable sites; it is illegal to sell testosterone pills over the counter in the US, and legitimate foreign pharmacies would not dispense these medications without a valid prescription. As such, you can be assured that the sources of these pills are not trustworthy and you do not really know what you are getting, if the pills contain testosterone, or how much testosterone they contain. At best, the pills may have no effect. At worst, they may present serious risks due to contamination, substitution, dangerous formulation, or excessive dosage.
The Dangers of Too Much Testosterone
Testosterone is a natural substance that plays an essential role in a wide variety of physiological functions. Men who struggle with the symptoms of low testosterone understand this better than most. But there are also very real dangers of having too much testosterone. While describing someone as having “too much testosterone” is typically code for saying they have anger or aggression issues, the actual effects of excessive testosterone are very different—and even more alarming. These include:
- Heart muscle damage
- Increased chance of heart attack
- High blood pressure and cholesterol
- Increased risk of blood clots
- Headaches and insomnia
- Lower sperm count
- Decreased testicle size
Men who use illicitly obtained testosterone pills may be particularly vulnerable to these effects. Not only do you not know exactly what you are taking, you also don’t know what level of testosterone is right for your body. Without professional oversight, many men take increasingly large doses as they attempt to amplify the positive effects of testosterone, often far surpassing healthy limits. In other cases, the lack of reliable, predictable formulation in black market products could cause you to overdose without even realizing you are putting yourself at risk.
The Best Way to Safely Treat Low T
Testosterone pills and over-the-counter testosterone products may seem attractive at first glance, but they are unlikely to adequately address your symptoms and, in some cases, they can put your health in peril. But doing nothing can also present significant risks to your physical and emotional well-being, and your low testosterone may be caused by an underlying health issue that needs to be addressed. As such, if you think you may have low T, it is critical to seek professional care.
To begin, a skilled practitioner who specializes in hormone health will test your hormone levels to establish whether you are in fact suffering from androgen deficiency. They will then conduct a thorough assessment of your overall health to gain a better understanding of your symptoms, the cause of your hormone imbalance, and your suitability for TRT. If you are considered to be a good candidate for testosterone replacement therapy, they can explain your options and give you the guidance you need to make the best choice for your individual situation.
Many men who chose to pursue TRT feel most comfortable using custom-compounded bioidentical hormones to replenish their testosterone levels and alleviate their symptoms. Unlike synthetic testosterone, bioidentical testosterone is derived from plant material and is an exact match to your body’s natural hormones. Because the treatment is custom-compounded just for you, you can get the exact dose you need in an administration method that works for you. For example, if you want a steady, consistent dose of hormones that only requires an office visit every few months, testosterone pellet therapy may be the best option. On the other hand, if you prefer a completely non-invasive method, patches, creams, or gels could be a better choice.
By working with a qualified hormone health practitioner, you can find the treatment you need to safely and effectively address your low T. Moreover, your progress will be closely monitored over time to ensure that your treatment continues to be appropriate and work for you as you age.
For Robert, TRT has been life-changing. “Looking back, I can’t believe I considered over-the-counter testosterone products or buying testosterone pills online,” he says. “By going to my doctor a few times a year for pellets, my symptoms are kept at bay and I don’t have to worry about what I’m putting in my body. I feel like I got my life back.”
If you are looking to increase your testosterone levels, BodyLogicMD can help. Practitioners in the BodyLogicMD network are experts in hormone health and committed optimizing your health using the most innovative techniques available. If you’re ready to address your symptoms and enhance your quality of life, a BodyLogicMD-affiliated practitioner can help you set meaningful wellness goals and create a custom treatment plan to help you achieve them. Contact a local practitioner in your area to start your journey, or take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones impact your everyday life.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.