What About Men?
Tired? Got the blues? Maybe testosterone can help. Or not.
Skeptics. More than a few researchers worry that American men risk repeating the sorry tale of the nation's women, who for decades took estrogen supplements after menopause in the belief it would protect them against heart disease. Only recently, through new research from the Women's Health Initiative, have they discovered that the opposite is true. Add in the huge marketing push for "testosterone replacement therapy" by the pharmaceutical companies hawking the stuff, which has waxed just as enthusiasm for women's hormone replacement therapy has waned, and there's more than a little reason to be skeptical. "Because of what we've learned from the Women's Health Initiative, it's very important to be cautious and not assume that a single hormone can be therapeutic," says Linda Fried, director of the Center on Aging and Health at Johns Hopkins University. Fried served on an Institute of Medicine panel that called last year for more research on testosterone therapy--and extreme caution in using it until the research is done. Because so little is known, the IOM panel said, scientists should look first at frail men over 65 with clear testosterone deficiencies, because they would be the most likely to see benefits. Those studies will take at least four years to yield information, according to NIA's Hadley. Research on the much larger cohort of healthy men, ages 50 and up, who may be interested in using testosterone to fight symptoms of aging, would take longer. That research would also be more controversial, because the men involved would face potential long-term risks with less clear benefit.
Few physicians would argue that a man with very low testosterone, which can cause infertility, enlarged breasts, and muscle wasting, should seek treatment. The larger question is whether "male menopause" should be treated--or if it even exists. Where a woman's production of estrogen plummets at menopause, ending fertility, men's testosterone levels subside very gradually, declining by about 1 percent a year starting around age 30. But an individual's testosterone levels can fluctuate a great deal through adulthood, and men in their 70s are still capable of fathering children. There is no "pause" in "andropause." Even diagnosing clinical testosterone deficiency--the technical name is hypogonadism, which affects 2 million to 4 million men in the United States--is tricky, since the blood tests most commonly used aren't very reliable. (A total serum testosterone level below 200 is considered deficient, while 30-year-olds have a mean level of 600, compared with 400 at age 80.) And the symptoms listed for andropause, which include decreased sex drive, fatigue, loss of strength and muscle mass, and difficulty concentrating, could apply at some point to just about every older man--or older woman for that matter.
"The resistance to the idea of testosterone is that it's very common for all sorts of things to decline as we grow older," says Abraham Morgentaler, a urologist at Beth Israel Deaconess Medical Center in Boston, who reviewed existing studies on testosterone's safety in a recent New England Journal of Medicine. Although Morgentaler monitors his patients for prostate cancer with biopsies and blood tests, he describes himself as a "cheerleader" for testosterone therapy, saying it treats the biggest sex organ of them all--the human brain. "If a man comes in with low sexual desire and fatigue, there's a good chance that testosterone will be a home run for him."
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