Male menopause and testosterone replacement therapy

Who’s on first?

There’s an old Abbott & Costello routine where Abbott tells a perfectly healthy Costello that he looks sick. I don’t recall what Abbott’s motive is in planting this suggestion with his impressionable pal, but he quickly convinces Costello that he’s in serious need of medical attention.

A marketing campaign is underway right now that resembles this routine. Abbott is played by a pharmaceutical company named Unimed, and their intended “Costello” is every man who’s over the age of, say, 45 who may not feel quite as young or strong or virile as he used to.

Unimed is out there, men, and they want to “raise your awareness” about male menopause. Their remedy: testosterone replacement therapy (TRT).

Things change

As men grow older, their testosterone levels drop a little more than one percent each year after the age of 40. This typically results in a condition now dubbed andropause – also called male menopause – which manifests with moodiness, memory loss, a gradual decline in sex drive, and a lack of energy, strength and endurance. Other less obvious problems are the decrease of lean muscle mass and bone mineral density in the spine. Taken together, these conditions often conspire to create a gradual passivity and disinterest in life.

The question is: Should andropause be accepted as a normal part of aging, or should it be regarded as a medical condition that requires treatment? Ultimately, that question can only be answered individually by each man experiencing andropause. For those who choose to address the problem, there are several avenues available, including specific exercise regimens, a variety of natural supplements that help your body raise its own testosterone levels, or testosterone replacement therapies.

In the opinion of Unimed, however, testosterone replacement therapy is the only way to go. There are other pharmaceutical companies out there that offer TRT in the form of pills, patches and muscle injections, but Unimed’s AndroGel – approved by the FDA two years ago – is the fastest growing and most aggressively marketed TRT.

Testosterone is the big daddy of the androgens – male sex hormones responsible for the development of sperm and sex characteristics in general. AndroGel takes its name from androgen, of course – that and the fact that it’s a gel that users rub on their shoulders once each day. A month’s supply isn’t cheap, running about $250 dollars, and a trip to the doctor is required because it’s a prescription drug. But not all physicians will prescribe AndroGel. Apparently there are still some doctors out there who are unconvinced that andropause should be treated by replacing testosterone.

That’s why Unimed has aimed its andropause “awareness” campaign at both doctors and patients alike. But some very special marketing strategies have been devised for the medical side of the campaign.

Buying results

In April, 2000, the Endocrine Society held its First Annual Andropause Consensus Conference. Their goal: define andropause and assess the need for treatment.

A panel of 13 respected endocrinologists concluded that andropause is a genuine health concern and that all men over the age of 50 should be screened for a deficiency of testosterone. In setting the bar for when a man should be prescribed treatment, they decided on the parameters for a “normal” range of testosterone levels in blood samples, even though their one-size-fits-all normal range matched the typical range for men in their twenties.

The panel stopped short at recommending specific treatments, but for anyone prepared to mount an “awareness” campaign, the official acknowledgement of andropause as a condition suffered by millions in need of medical treatment was as good as gold.

And who provided the grant that was the only source of funding for the conference? Unimed. That fact was well known. What was not reported until recently, however, was that 9 of the 13 conference panelists (including the chair and co-chair) had financial ties to Unimed by the usual means that pharmaceutical companies “employ” medical professionals: through grants for research, and fees paid for consulting assignments and speaking engagements.

Not so fast

One of the primary problems with recognizing andropause is that the method of diagnosis by reading testosterone levels is unreliable. Studies have shown that throughout the day a man’s testosterone level may vary widely. So a reading at 6:00 AM might indicate that a patient has a very low level, while a reading from the same man an hour later might report a level that would require no additional input of testosterone.

And for those who choose to treat andropause with pharmaceuticals, what are the long-term effects of TRT? No one knows because no long-term studies have been conducted. So until we see the effects that the drug produces over a period of several years, there’s no way that TRT can be regarded as safe. This is especially so in light of the fact that known TRT side effects include testicular shrinkage, abnormal enlargement of the breasts and an elevation in circulating blood cell level which can lead to stroke and heart failure.

In addition, existing prostate cancer cells are stimulated into rapid growth when additional testosterone is introduced into the system. So you could assume that no doctor will prescribe TRT to a patient who is at risk for prostate cancer, but some prostate cancer cells are simply too small to detect. Introducing testosterone to these tiny, slow-growing cells is like putting a super-grow fertilizer in a garden.

Forty years ago, pharmaceutical companies were telling women that estrogen was the answer to menopausal problems such as sexual health and moodiness. At the time there were no long term studies to rely on for information, so the marketing ran far ahead of safety. Through the years many women have paid a dear price for trusting hormone replacement therapy. In 2042, will we be saying the same about men who put their faith in an expensive gel?

To Your Good Health,
Jenny Thompson

Health Sciences Institute