Case reports regarding testosterone supplementation leading to changes in hair patterns have been documented; however no randomized, placebo-controlled trials exist. While polycythemia may be an adverse side-effect, this is a potential benefit in patients with chronic renal failure and anemia. In patients with end-stage renal disease (ESRD) on dialysis, fluid shifts are less of a concern in patients on TRT since the fluid retention can be handled with dialysis. Combined therapy with testosterone and other treatments, such as PDE-5i, is advantageous in some cases and is valuable for patients with hypogonadism who failed PDE-5i therapy alone. PSA is not the perfect marker for prostate cancer; so, several studies have tried to clarify if TRT increases the occurrence of prostate cancer. For a long time, it was believed that higher testosterone concentrations increased the risk of prostate cancer or caused rapid cancer growth, while low testosterone concentrations would have a protective outcome. People often ask whether 500 ng/dL is a good level of total testosterone. "We are now seeing a lot of young patients with low T, which is due to environmental factors," McDevitt says. Testosterone levels peak in the earlier phases of life as a teen and young adult (6). For men, the goal is usually to bring testosterone into the normal range for healthy men and match that to clinical response. To determine if shilajit really boosts testosterone, we must look at quantifiable data from controlled human trials rather than relying on animal studies or theory alone. This unique chemical profile explains why shilajit is investigated not just for testosterone, but for overall cellular health and longevity. Whether it's dragging yourself out of bed, hitting a wall during workouts, or feeling that spark fade in the bedroom, declining testosterone levels are often the silent culprit. TRT, when given to appropriately selected patients with vigilant monitoring as outlined in this review and in Table 1, can bring improvements in quality-of-life, energy level, libido, muscle mass, cognition and bone density. Data on the safety of TRT specific to our aging population is not currently available; however TRT has been linked to prostate cancer, BPH, polycythemia and OSA. When testosterone reaches supra-therapeutic levels, aggressive behavior and increased rates of suicide among adolescent users have been reported; however, no study has documented a negative impact on cognition in men patients receiving TRT. Descriptive, observational, and experimental studies including healthy men-more especially, those assessing the effects of testosterone therapy-were required for inclusion. Yassin et al. showed that TRT does not increase the risk for prostate cancer when compared to healthy men and recommended further investigations to truly understand the complex relationship between prostate cancer and testosterone. A plethora studies have not demonstrated testosterone concentrations to be higher in men with prostate cancer compared to those without cancer. In addition, advances have been made in enhancing the role of testosterone as a metabolic hormone with favourable effects on 1) Sexual function; 2) Obesity; 3) Muscles vs fats; 4) Bone health; 5) Blood formulation (anaemia); 6) cardiovascular effects and blood pressure; 7) Renal function; 8) Liver function and steatosis; and 9).
