What About Men?
Tired? Got the blues? Maybe testosterone can help. Or not.
When Joe Marcklinger hit his 50s, he found himself feeling tired and blue--way too often. He tried taking antidepressants but had a hard time accepting one of the drugs' most common side effects--sexual dysfunction. Then Marcklinger's wife, Maureen, a psychiatric nurse, heard about research using the male sex hormone testosterone to treat depression. She urged her husband to check it out. "Within a few days I started feeling mentally better," says Marcklinger, 57. "I started feeling more energy." He now finds it easier clambering over fences while on the job with his surveying business in Sudbury, Mass., and has better muscle tone. "You know how older guys look weak? I'm not like that." Things are better in the bedroom, too.
In the past few years, the number of men taking supplements of the male sex hormone testosterone has soared, fueled by baby boomers feeling the slights of middle age. The market has also been boosted by the availability of skin gels that are much easier to use than the unpleasant injections or dangerous pills of years past. The number of men taking "testosterone replacement therapy" increased 29 percent from 2001 to 2002, when nearly 2 million prescriptions were written, and the Internet is awash with ads selling the sex hormone--despite the fact that testosterone is available only by prescription. The Web site for AndroGel, one of the leading treatments, shows the needle of a gas gauge drooping at Empty. "Fatigued? Depressed mood? Low sex drive?" the site asks. With "testosterone restored," the needle leaps to "Full."
Risks. Only one problem: There's no clear proof that testosterone replacement therapy combats fatigue, depression, or low sex drive in healthy men. In fact, there's little proof of either the benefits or the risks of supplemental testosterone, because no large, long-term studies have been done. Although there are intriguing hints that testosterone may reduce age-related bone and muscle loss, there are also ominous suggestions that extra testosterone could be life threatening. The No. 1 concern: prostate cancer. Suppressing testosterone slows both prostate cancer and benign prostatic hyperplasia, and about half of men over age 50 have undetected cancer cells in their prostate glands. Adding testosterone may also increase the risk of stroke-causing blood clots, cardiovascular disease, and sleep apnea. But no one knows for sure. "It could be that testosterone therapy may have an important preventive role," says Evan Hadley, an associate director at the National Institute on Aging. "Right now we just don't know." The NIA recommends testosterone therapy only for the relatively few men with extreme deficiencies, saying that it's otherwise "not deemed appropriate therapy for most men at this time."
But that's not stopping Marcklinger and lots of other men with relatively normal testosterone levels. Well aware of the controversy surrounding testosterone therapy and prostate cancer, he underwent a prostate biopsy to look for cancerous cells before starting treatment and has his PSA level checked every six months. He says he'd undergo a biopsy again in a minute if that's what it would take to stay on the drug. "I went to [talk] therapy for depression, or midlife crisis, and found that helped. But this really is a fix."
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