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Despite the risk of infertility and fatal blood clots

By Eve Simmons

Hormone experts have warned that private clinics are putting young men at risk of infertility and potentially fatal blood clots by selling them unnecessary testosterone injections.

While advocates claim the jabs help men with low testosterone ‘regain their health, vitality and return to a fulfilling sex life’, they also shut off the body’s natural production of the male hormone – potentially triggering a host of complications when misused.

And it is this that is causing concern, as its use soars among young men desperate to match the muscular physiques seen on shows such as Love Island, as well as older men seeking to recapture the vigour of their youth.

Doctors from the Society For Endocrinology will be issuing a statement claiming that this growing trend for testosterone replacement therapy is ‘dangerous’. Dr Channa Jayasena, head of male reproductive health at Imperial College London, said: ‘We’re seeing more and more men becoming very unwell because of taking these drugs, and we are having to pick up the pieces.’

Testosterone is naturally produced by both sexes, but men have more of it. In men, the hormone is made in the testes and is responsible for a host of functions, including maintaining sexual function, sperm production, distributing fat around the body, bone growth, healthy blood vessels and mood regulation.

Testosterone deficiency is known medically as hypogonadism, a condition that causes late puberty, irregular development of the genitals and gynaecomastia – growth of excessive breast tissue. For these men, injections of testosterone are vital to restore their levels back to normal.

But for healthy men, an excess of the hormone triggers signals from the brain to the testes instructing the organs to stop making it.

Dr Richard Quinton, consultant endocrinologist at the Royal Victoria Infirmary and a researcher at Newcastle University, says: ‘This is a treatment for a small minority of patients who don’t produce their own testosterone, which can be a serious health problem. But it is being marketed to young healthy men as a way to improve their results in the gym, or older men who want to do something about their middle-age spread.

‘Testosterone replacement therapy can increase the risk of blood clots, trigger mood problems and a host of other fertility-related complications, including erectile dysfunction and shrinkage of the testicles.’

As part of this article, we learned about one patient who was left suffering ‘extreme shrinkage and unbearable pain’ in his testicles – three years after he stopped taking testosterone. He will now require a surgical procedure to cut the nerves in his groin in order to ease his discomfort.

Dr Jayasena adds: ‘When you start taking testosterone you feel like Superman, so it is very hard to stop. Patients can become dependent on the drugs.’

Testosterone is naturally produced by both sexes, but men have more of it. In men, the hormone is made in the testes and is responsible for a host of functions, including maintaining sexual function, sperm production, distributing fat around the body, bone growth, healthy blood vessels and mood regulation

Studies show that demand for testosterone jabs and creams has risen by at least 20 per cent over the past decade, with the market set to be worth nearly £2 billion by 2027, according to recent analyses.

In the UK, experts say the growing demand is partly spurred by the so-called ‘Love Island effect’ – with young men trying to emulate the muscular physiques of the ITV2 reality show’s male contestants. ‘The super-muscly look made popular on Love Island is definitely driving this trend,’ says Dr Jayasena. ‘Men picked to be on the show have exceptional athletic physiques, with washboard abs and huge biceps.

‘But young guys watching this begin to think that’s normal and that there’s something wrong with them because they work out and lift weights but don’t look like that.

‘And then along comes a clinic, staffed with seemingly reputable doctors, who say, “You’re not getting the results you’re after in the gym because you’re not producing testosterone.” ’

In recent years a deluge of clinics has popped up on high streets and online specialising in the treatment. Adverts feature images of men with bulging, toned arms or six-packs. Meanwhile, high-profile figures and celebrities are said to be happy customers – including podcaster Joe Rogan, who attracts 11 million listeners to his shows about men’s issues, and singer Robbie Williams.

Patients post positive reviews on the clinics’ websites, crediting ‘transformative’ testosterone for getting them ‘in the best shape of my life’. One 27-year-old writes: ‘My hair is thicker, I’ve got a beard (no more baby face) and my abs are back. I am running 30km per week and do loads of body exercises.’ Another, by a 30-year-old man, tells of the ‘substantial benefits at the gym, and with the ladies’.

Elsewhere, middle-aged men describe using the hormone to hang on to their youth. A 58-year-old man says that after two years of treatment, his libido and body fat levels have returned to where they were when he was 25.

Andrew Carruthers, managing director of London-based Centre For Men’s Health, who prescribes testosterone treatment, says: ‘A few years ago, most of our clients were in their 50s and 60s, but now we are regularly getting calls from 20 and thirtysomethings.

‘Occasionally, when you dig in a bit, you realise they’ve hit a wall in the gym and an internet search has told them testosterone might help.’

In response to this trend, the Society For Endocrinology, which represents all hormone specialists and leads all hormone treatment in the UK, warns: ‘Such clinics are actively promoting non-evidence based practices. This places potentially vulnerable patients at risk of unnecessary treatment, which is dangerous. Any instances of inappropriate testosterone prescribing should be investigated and stopped.’

One man who credits the hormone for helping him achieve ‘optimum health’ is Mike Kocsis, who has been self-injecting the hormone for 26 years. The 48-year-old from London is so passionate about its benefits that he has set up a clinic offering it to other men, called Balance My Hormones.

He say that aged 22 he found himself feeling ‘constantly exhausted’ and with a ‘diminishing libido’. He visited a doctor in the US – where he was living at the time – who performed blood tests and found his levels to be ‘at the lower end of normal’. He says: ‘The doctor suggested I try taking testosterone to top-up my levels. So I did, and I haven’t looked back since.’

Within a few weeks of applying a testosterone cream to his genitals he says he had increased energy and ‘no longer felt like a 70-year-old grandfather’. ‘I soon switched to injections and got my sex drive back, which made me feel much more like a man of my age again.’

Today, Mike – who sports an impressively muscular physique – injects himself three times a week with testosterone alongside two injections of another hormone called human chorionic gonadotropin, or hCG, to counter one of the side effects: testicular shrinkage.

Does the risk of side effects not concern him? ‘I had a sperm count about five years ago and I have more than enough for my age – plus 75 per cent have good motility,’ he answers confidently.

Over the past decade, scientists have raised concerns about the dwindling levels of testosterone among men worldwide. Studies have shown a 20 per cent decline in all ages, and a 25 per cent drop among adolescents.

So does this mean more men could be suffering a genuine deficiency, and these clinics are simply providing much-needed medical help?

‘There is no good-quality evidence to suggest hypogonadism is increasing among young men,’ says Dr Quinton. ‘The symptoms these men are suffering can easily be due to other, common things – like mental health issues, for instance.

‘And it is easy to get a low testosterone level on a blood test if you don’t conduct it properly. I suspect that’s what is going on here.’

Guidance from the Society For Endocrinology and the British Society For Sexual Medicine say two blood tests, a few weeks apart, must be used to test for testosterone deficiency. ‘They have to be taken at around 9am, which is when testosterone is naturally highest,’ says Professor Pierre-Marc Bouloux, consultant endocrinologist at The Royal Free Hospital in London. ‘All too often, patients pop in for these tests after work, when testosterone is naturally low, and they’re told they have a deficiency.’

Patients are then tested for signs of underlying causes, such as pituitary and prostate cancer, both of which can affect testosterone production.

Some of the private doctors also believe in the so-called ‘manopause’ – where dwindling sex hormones in middle age causes slumps in energy and sexual dysfunction. Experts say that while testosterone does dwindle with age, only a very small percentage of men will reach levels low enough to trigger symptoms.

‘Some studies suggest as many as 30 per cent of men aged over 50 are affected, while other, better-quality research, shows the figure to be two per cent,’ says Prof Bouloux. ‘The true figure is likely to be around ten per cent, and most of these men have underlying conditions that are causing the problem, so treating those should be the priority, not offering testosterone.’

Obesity and type 2 diabetes can affect the balance of hormones within the body, as can certain medications and brain injuries that affect the pituitary gland – the gland which tells the testes when to make testosterone.

‘Studies have shown that even heavy snorers who don’t inhale enough oxygen into the blood as they sleep can reduce their testosterone levels,’ says Prof Bouloux. Losing weight and cutting down on smoking and drinking, thereby reducing snoring, can see testosterone level ‘shoot back up’ within days, he adds.

But there are other even more serious side effects.

Excess testosterone can trigger an over-production of red blood cells, increasing the risk of clots, leading to heart attacks and strokes.

One patient said that thanks to testosterone replacement therapy he’s been forced to have blood removed four times to prevent an imminent heart attack or stroke.

And coming off testosterone presents another challenge.

While fertility problems usually resolve within six months of stopping treatment, many patients are not able to give it up.

‘The problem is that once patients stop taking testosterone, they immediately experience the symptoms of severe deficiency, which can be very unpleasant for a few weeks,’ says Prof Bouloux.

‘Many feel they have no choice but to go back on the testosterone. And the longer you take it, the greater the risk that problems won’t resolve. So these private clinics are creating problems rather than fixing them.’

One 33-year-old patient who self-injected testosterone for two years has told of complications that have persisted three years after he stopped.

Writing on a patient forum, he said: ‘I have had a lot of fatigue, nipple sensitivity, deep acne, sweating and ED [erectile dysfunction] issues on top of unbearable pain in my testicles.’

Some clinics offer a cocktail of other drugs to counter the effects of testosterone on fertility.

Clomid is one example. It is usually given to help women ovulate, which can also boost natural production of testosterone and other reproductive hormones. Human chorionic gonadotropin (hCG) works in a similar way.

Mr Kocsis began taking hCG five years ago when he became ‘bothered’ by his shrinking testicles. ‘You can’t have your cake and eat it,’ he shrugs. ‘You give up something to gain something else.’

Similar treatment protocols are discussed on online forums for bodybuilders who take anabolic steroids – high doses of synthetic testosterone that can trigger dramatic muscle growth.

‘Bodybuilders call it “stacking” – mitigating the effects of steroids by using other drugs,’ says Dr Quinton. ‘These protocols are not endorsed by any reputable guidelines. Clomid tends to reduce libido, which is inconvenient, and may also increase the risk of thrombosis, while hCG can promote breast development.’

But some experts are more welcoming of wider access to testosterone replacement therapy.

‘Private clinics will always pop up to fill a vacuum in NHS treatment – and, to some extent, that is what is happening here,’ says Dr Mike Kirby, Professor of Primary Care and former treasurer at the British Society For Sexual Medicine. While giving testosterone to younger men is ‘inappropriate and could cause serious harm’, there is a ‘definite unmet need in older patients’, he adds. ‘Testosterone deficiency is not managed well in general practice, mostly due to a lack of knowledge in this area among GPs. There are older men suffering sexual problems who would benefit from testosterone therapy but aren’t getting it. If they can’t get help from a GP, you can’t blame patients for trying the private sector instead.’

Even if obesity or diabetes is the underlying problem, in some cases giving testosterone may not be such a terrible idea.

‘If an older patient has poor energy levels and is not motivated to lose weight because of a deficiency, giving a small, controlled dose may nudge them along,’ says Prof Bouloux.

‘A careful endocrinologist would do a three- to six-month trial and closely monitor the patient.’

Mr Kocsis says that he’s aware of the criticisms but stands by the ‘transformative’ benefits of testosterone.

‘The NHS is stuck in the dark ages with this,’ he says. ‘Endocrinologists need to take the lead from US doctors, who don’t dismiss testosterone but are willing to try it because there’s a chance it might help.’

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