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Andropause Research
Andropause research studies suggest that osteoporosis, Parkinson's disease and depression, particularly late onset depression, may be helped by extra testosterone.
And, of course, a major benefit appears to be better sex.  New statistics from the US - where 800,000 or so middle-aged and elderly men have been taking testosterone for more than 10 years - suggest that the market for Viagra is expanding only among younger men, who use it for recreational purposes. And a study from Columbia University Medical Centre, published last month, found that testosterone combined with Viagra is better at promoting erection as well as improving libido, thereby improving overall sexual satisfaction for both partners.
Until now, the debate over testosterone has been muted by fears that it causes prostate cancer - a similar debate, says Dr Carruthers, to the longrunning concerns over the link between HRT and breast cancer. And there is evidence that testosterone stimulates existing hormone-sensitive cancers, including prostate and, more rarely, breast cancer in men, says Dr Mark Fenley, a senior lecturer in urology at University College London. "It means that doctors have to rule out prostate problems before prescribing testosterone, as well as provide regular monitoring."
Andropause researchers have come up with another possiblity: instead of giving extra testosterone, doctors can prescribe a drug that sets free more of the body’s own testosterone -by reducing the level of sex hormone binding globulin (SHBG), a hormone that increases with age and under particular conditions, including thyroid problems. Many people who appear to have the symptoms of low testosterone show up in tests as being only mildly deficient - but have elevated SHBG, which reduces the amount of "free" testosterone. Dr Carruthers, for example, has treated low testosterone levels with low doses of Danazol, a synthetic steroid that has been used safely for decades to treat endometriosis in women. The Andropause Society insists that testosterone deficiency is a different condition from a mid-life crisis, which happens earlier and frequently brings an increase in men's sex drive as a form of escapism. Psychiatrists, however, see the symptoms associated with low testosterone as typical of the clinical depression that frequently occurs in 50- plus men following bereavement, the diagnosis of a physical illness or simply as a result of anxiety about ageing and changing roles, because of retirement or children leaving home.
"Doctors are getting much better at recognising depression in older men who tend not to come forward to seek help, and are more confident about treating these symptoms with antidepressants," says Dr Jim Boulton, a psychiatrist.
"But it's unlikely that a psychiatrist would measure testosterone levels." The clinical psychologist Derek Milne, author of Coping With A Mid-Life Crisis, says that low mood and low sex drive will almost certainly have both a physiological and psychological background. "Of course, drugs can help when prescribed appropriately. But people also need to review their lives, to find better ways of coping with low mood or low sex drive or simply changing circumstances.
"It's OK to get grumpy in moderation but after a while, it gets boring. Far better to adapt to a changing world and find new challenges and new seas to conquer." Excellent advice, no doubt - but perhaps easier to achieve, for some men at least, with a decent daily infusion of what Dr Carruthers calls the "hormone of kings, king of hormones".
Drew Voight
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