The Other Pause
With all the attention given to the health challenges that come with menopause, it’s important to remember that midlife isn’t exactly a cakewalk for men. Andropause is the male counterpart of menopause, complete with hormonal changes that present a number of key health issues.
I recently received an e-mail from an HSI member named Ron who wrote: “Can you please do an article on hormone replacement therapy for men? I see a lot of conflicting information and yet it seems to help a lot of people.”
Right on both counts, Ron. Some men swear by hormonal treatments. But according to a major report from the Institute of Medicine, various factors of this treatment represent unknown quantities that are potentially dangerous.
Here’s what we know about andropause: As men grow older, their testosterone levels drop a little more than one percent each year after the age of 40. This can trigger a variety of symptoms, such as moodiness, memory loss, a decline in sex drive, and a lack of energy, strength and endurance. Other less obvious problems include the decrease of lean muscle mass and bone mineral density in the spine. Taken together, these conditions sometimes cause men to experience a gradual passivity and disinterest in life.
But going gentle into that good night is not acceptable to many men. For those who choose to address the problem there are several therapies available, including exercise regimens, a variety of natural supplements that help your body raise its own testosterone levels, or testosterone replacement therapy (TRT). About three years ago the FDA approved TRT for the treatment of low testosterone production called hypogonadism. Since then, many doctors have exercised the option of off-label usage to prescribe the therapy for other andropause symptoms. And they’ve had some help.
In the e-Alert “Who’s on First” (8/22/02) I told you about a campaign to promote andropause as a condition requiring medical treatment. That campaign has been aggressively promoted by Unimed, makers of AndroGel, a TRT formula that’s rubbed on the shoulders daily and costs about $250 per month. AndroGel dominates the TRT market of testosterone gels, creams, and patches, which accounted for 2 million prescriptions in 2002.
Not going long
In late 2003, a committee of the Institute of Medicine concluded a one-year review of existing TRT research. They found only 31 trials that focused on older men. Most of those trials used fewer than 50 subjects, all but one lasted less than a year, and many were not placebo-controlled.
In light of the quickly growing TRT market, the committee determined that the risks and benefits of TRT have not been adequately tested, especially in older men. And because some studies have also shown that testosterone therapy may increase the risk of prostate cancer (especially in those men who are already in a high-risk group), committee members called for doctors to immediately take greater care in prescribing TRT.
In addition, the committee recommended careful planning for upcoming trials in order to assess how TRT may increase the prostate cancer risk in older men, while excluding potential subjects who are already at high risk. They also recommend that short-term studies should begin, specifically designed to determine benefits of the therapy. They suggest that long-term studies should follow only if the shorter studies reveal clear benefits of TRT.
This strikes me as “short-term” thinking. If researchers conclude that long-term studies aren’t needed, doctors will certainly continue to prescribe the therapy and men will continue to demand it. Meanwhile, one of the problems with TRT right now is the fact that we don’t know exactly what problems may come with long-term usage. What we do know is that some studies have already revealed certain unpleasant side effects, including testicular shrinkage, abnormal enlargement of the breasts and an elevation in circulating blood cell level, which can lead to stroke and heart failure.
Don’t rush in
Apart from the existing research, there are many testimonials from men who have reported a boost in energy and libido while using TRT. But the use of this therapy as an anti-aging tool is scientifically unproven. In fact, committee chair Dan G. Blazer, M.D., told WebMD Medical News that, “the evidence is almost nil.” So in many ways, our knowledge of TRT now is similar to our knowledge of HRT a few years ago.
And if we knew then what we know now, the prudent advice to women would be the same as the Institute of Medicine committee’s advice with TRT: Tread very carefully with this therapy.
As I mentioned above, there are alternatives, including supplements, which have been shown to help men cope with andropause symptoms. For instance, Tribulus terrestris Linn is a botanical used in India for centuries to treat sexual dysfunction and promote rejuvenation in men. Formulas containing this herb are available in health food stores and through Internet sources.
Whether or not andropause should be accepted as a normal part of aging or regarded as a medical condition that requires treatment is a question that can only be answered individually by each man experiencing the symptoms of these changes. If you’re a man who’s 40-something or older and you’ve noticed changes in energy levels, sexual desires, or moods, share your concerns with your doctor.
Most importantly, weigh your options carefully before deciding which course to take. Because as we’ve learned too often, for better or for worse, short-term solutions can have long-term effects.
To Your Good Health,
Health Sciences Institute
“Testosterone Therapy Studies Should Determine Benefits First, Then Risks; Study Participants Should Be Limited, Carefully Screened” Committee on Assessing the Need for Clinical Trials of Testosterone Replacement Therapy, News Release, 11/12/03, nationalacademies.org
“Testosterone: Benefits, Risks Unknown” Jeanie Lerche Davis, WebMD Medical News, 11/12/03, webmd.com
“Testosterone Derided As a Health Supplement” Marc Kaufman, Washington Post, 11/13/03, washingtonpost.com