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Testosterone Therapy

There may or may not be such a thing as "male menopause" - and if there is, it may or may not be connected with a midlife urge to buy a red Corvette. Yet there's growing interest in testosterone therapy, especially among baby-boom guys who do not want to go gently into Grandpa Land. "It is sort of an anti-aging thing," said William Amin of the National Men's Health Clinic in Columbia.

Of 55- to 64-year-olds who come to the clinic with potency problems, about 85 percent now receive testosterone as part of their treatment, said clinic manager Chris Laughter. One study has projected about 481,000 new cases of androgen (male hormone) deficiency per year in men 40 to 69. Baby-boom men will want to be fitter, including being sexually active, into their 60s, 70s and 80s, said Shailesh Patel, an associate professor of endocrinology at the Medical University of South Carolina in Charleston. "This becomes a social issue, not so much a medical issue" for some men, he said.

An infusion of testosterone - the most potent of the male hormones - can have side effects and should be monitored. Not to mention the nuisance of needing a pill, wearing a testosterone patch, getting a weekly injection or having a daily slather of testosterone hormone gel. But Patel and other doctors said testosterone could supply a vital spark for the energy and libido of men whose testosterone levels had waned because of age or disease.

Testosterone Peaks

Testosterone peaks between the ages of 20 and 40, and goes into a small, steady decline after that. The National Institute on Aging says there's little evidence that "male menopause" occurs, noting that many older men have testosterone levels in the normal range. But especially in alternative-health circles, there's interest in using testosterone therapy to treat what some refer to as "andropause." Testosterone is touted as vital for preserving bone density, muscle mass and sexual function in older men.

Diseases of the pituitary gland and of the testes, where testosterone is produced, are among the conditions that call for testosterone therapy, Patel said. Symptoms may be similar to those of menopausal difficulties in women, he said, including fatigue, bone weakness, waning libido and even hot flashes. Age-related symptoms of testosterone deficiency tend to be a little more wishy- washy, Patel said. For example, loss of sex drive could be caused by a lot of things, including stress, depression, medications, marriage problems or trouble at work.

Men concerned about their testosterone levels should be tested in the morning, said Tu Lin, director of the endocrinology division in the USC School of Medicine in Columbia. Male hormone levels fluctuate throughout the day and are highest then, he said. If a man tested low in the afternoon, it would be hard to tell whether he had a deficiency. "It's important to know the "bioavailable" level of the hormone", Lin said, "because almost half of a man's testosterone binds with proteins in the body".

Lin said testosterone supplementation might worsen an enlarged prostate or existing prostate cancer, so a man's prostate and his level of prostate-specific antigen (PSA) should be checked before testosterone is considered.

Drew Voight

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