Testosterone Replacement Therapy in Ramadan

 

Ramadan is the ninth month of the Islamic calendar where Muslims refrain from eating and drinking (yes, even water) from dawn to dusk. The length of a fast varies across the geography of the world and it can be anywhere between 11 to 19 hours. If you observe Ramadan and are on testosterone replacement therapy you may have concerns about the permissibility, effectiveness, and safety of TRT during fasting.

The first concern–permissibility–can be allayed by the fact that the consensus of major schools of thought in Islamic jurisprudence is that you are allowed to take medication while fasting as long as it is not:

• Taken orally
• Of nutritional value
• Entering the digestive system

This means that from a religious point of view, the testosterone injection (Testosterone Cypionate), which is administered into the muscle, and testosterone gel (Testosterone Gel 1%), which is applied on the skin, can be taken while fasting. TRT will not invalidate your fast.

From a medical standpoint, TRT during fasting poses no serious risks (apart from the usual side effects) and may even be beneficial because of the changes in the body’s state while fasting.

Does Fasting Affect Testosterone Levels?

 

Testosterone levels fall while fasting

Research has shown that intermittent fasting can initially cause a transient increase in testosterone as it promotes the production of luteinizing hormone (LH) which stimulates the testes to create more testosterone. However, this effect is only temporary, and fasting leads to an overall decline in testosterone in the long term.

Fasting alters your circadian rhythm and thus results in variations in secreted hormones. Studies in healthy physically active young men have concluded that fasting, or any form of time-restricted eating, causes a drop in total testosterone levels in the body over time. Muscle mass and strength, however, are not negatively affected. As TRT maintains muscle mass, fasting while on it can cause healthy weight loss without affecting your physique.

Though every person’s biology is unique, it is safe to assume that generally men might experience low testosterone during a period of fasting. Lower testosterone means an increase in fatigue and lack of energy on top of the already limited energy of the body due to fasting. In such situations, men might benefit from TRT.

This doesn’t mean that any man who thinks of fasting should start taking supplemental testosterone on their own. You first need to get a medical evaluation and some blood tests done to determine your levels of testosterone and other hormones and then a qualified healthcare practitioner could prescribe TRT if you have a testosterone deficiency.

 

Fasting While on TRT

Do you need to stop testosterone replacement therapy while fasting in Ramadan?

No, not at all. A lot of men on TRT actually practice intermittent fasting to stay in shape and maximize the benefits of testosterone.

There are several types of intermittent fasting methods, but the most popular ones are:

• The 16/8 method: A fasting period of 16 hours and an eating window of 8 hours
• The 5:2 diet: Normal meals for 5 days and calorie restriction for 2 days
• 24-hour fasting: A whole day of fasting once or twice a week
• Alternate day fasting: Fasting or calorie restriction every other day

Fasting is a science-backed way of losing weight and staying healthy. Adding fasting to TRT can greatly improve the health of men with testosterone deficiency. TRT restores testosterone levels and can lead to enhanced strength and muscle mass, higher bone density, increased energy levels, and an overall sense of well-being. TRT also has a positive impact on men’s mental health and sleep. More vigor and a better mood make fasting less difficult and consequently, several men find it easier to fast while on testosterone replacement therapy.

 

Testosterone gel

Testosterone gel 1% is a topical preparation of the hormone that can be applied to the skin on the upper arms, shoulders, and abdomen. It is an effective, Health Canada-approved treatment for testosterone deficiency and is generally well tolerated. Your testosterone levels will be monitored within 1-2 weeks of treatment, by which time they’ll have started to improve.  Relief of symptoms may take up to 3 months to become apparent to you.

Testosterone gel can be safely used while fasting after consulting with your healthcare provider. Common side effects you might experience include skin irritation and acne; while fluid retention, which may cause swelling in the ankles and feet, and an increased red blood cell count are less common but will need to be evaluated by your doctor.

 

Testosterone injections

Testosterone cypionate or Depo-testosterone is an injectable form of testosterone that is administered into the muscle every two weeks. It is a long-acting and convenient method of TRT approved by Health Canada. Your testosterone levels will be evaluated after 3 to 4 cycles and then after 3 months. Results of TRT through injections will start appearing within 3 weeks but will be fully experienced after 3 to 6 months. You can safely use testosterone cypionate while fasting after a testosterone deficiency consultation. Typical side effects include pain and swelling at the injection site, acne, and headaches, but sometimes the injections can cause polycythemia (increased red blood cells), fluid retention, and heart and liver problems. This is why it’s important to precisely follow the therapy guidelines given by your healthcare practitioner.

 

While on TRT, other parameters that will be monitored include prostate-specific antigen (PSA), full blood count (FBC), lipid profile, glucose, blood pressure, and body mass index (BMI). Stay in touch with your doctor and comply with the monitoring to ensure better results.

 

Not everyone can take TRT. It is not suitable for those with:

• breast cancer or prostate cancer
• prostate nodules, induration (thickening due to inflammation), or high prostate-specific antigen (PSA) levels
• elevated hematocrit levels and blood clotting disorders such as thrombophilia
• untreated and severe sleep apnea
• congestive heart failure, or a history of stroke or heart attack

 

How to fast safely on TRT

While testosterone replacement therapy can vastly help men with low testosterone levels improve their symptoms and quality of life, it is always important to discuss the potential risks and benefits of TRT with a licensed healthcare provider before starting or continuing the treatment during Ramadan. Make sure you inform your doctor of any pre-existing conditions you have or any medications you are on so they can guide you accordingly.

In general, it is best to practice the following while fasting:

• Eat a well-balanced meal during Suhoor (pre-fasting meal) and Iftar (fast-breaking meal)
• Do not limit Suhoor to carbohydrates, eat more grains and protein
• Avoid over-indulging during Iftar
• Drink plenty of water with electrolytes before and after fasting
• Avoid fried, sugary, and fatty foods
• Get proper sleep during the night
• Engage in low-intensity activities during the fast
• Abstain from fasting if you’re severely ill or weak

If you feel that your usual pre-Ramadan TRT dosing time is causing problems while fasting, talk to your doctor about making adjustments. You may be able to take TRT around meal times (Iftar or Suhoor) instead of during the fasting period. Any new or worsening symptoms you experience should always be reported to a qualified practitioner.

 

 

Disclaimer:

The opinions shared in this article belong to the author and, like all content on Gambit’s Health Hub, should not be considered a replacement for professional medical advice, diagnosis, or treatment. If you have any health-related inquiries, consult with your preferred healthcare professional or visit a licensed, Canadian physician through Get Gambit for a supported condition.

This article has been medically reviewed by:

Dr. Taneer Ahmed, MBBS, MS