Testosterone

Medical Meanderings 12 September 2007

Testosteroni: The Elderly Man’s Treat?

I think age is a very high price to pay for maturity.
- Tom Stoppard (1937 - )

It’s likely that anyone reading a weekly medical column has heard of menopause, or “the change” as many women call it. Menopause is the normal, age-related process of decreasing estrogen levels in the woman’s body, causing classic symptoms like hot flashes (or flushes), thinning of the bones, and lack of menstrual periods. Recently, however, there has been talk in some medical circles of an “andropause,” or male menopause, caused by declining testosterone levels in older men. Is there anything to this idea of “andropause”?

As men age, the level of testosterone in their blood normally decreases to some extent. Unlike menopause, however, there’s not a huge drop in hormone levels and, so far, the symptoms caused by this change aren’t clearly defined. Nevertheless, believers in “andropause” seem to think backward. They reason as follows: since many symptoms of aging in men are similar to symptoms of low testosterone in young men (called hypogonadism), it is reasonable to assume that low testosterone may cause many of the symptoms of aging. This is a tricky bit of flawed reasoning (called “argument by analogy,” for you logic buffs), and the link has not been supported by scientific evidence so far. Just because low testosterone and aging have similar results does not mean one causes the other.

Then the question arises: Even if it’s not an obvious disease, if we can, shouldn’t we fix problems such as age-related loss of bone, loss of sexual function and loss of muscle mass and strength? If an older man has declining testosterone and these problems, shouldn’t giving him some testosterone help get back his strength and mojo? Not necessarily. The available medical studies (and there aren’t that many) on testosterone treatment show that making the hormone level normal does NOT improve bone density, sexual function, quality of life, muscle strength or physical function.

Not only is aggressive testosterone replacement in older men apparently ineffective, it may be harmful. Both prostate enlargement and prostate cancer depend on testosterone, so giving more can worsen these problems. Testosterone treatment also worsens sleep apnea, increases the percentage of red cells in the blood (which may increase risk of heart attack) and lowers good cholesterol. It’s no magic elixir of youthful manliness.

Just as recent studies have made us doctors seriously question whether we should be trying to undo the changes that women experience as they go through menopause, it may be time to reconsider testosterone replacement in older men. It should probably be reserved only for those patients with severe, proven hormone problems, not for those older men who would just like more pep (or a younger girlfriend). In fact, it may be time for us all to reconsider the common view that aging is a disease that needs to be cured. Just as we don’t try to stop the changing of the seasons or the falling of the leaves, perhaps we shouldn’t stubbornly try to reverse those inevitable signs that our bodies have been around for awhile.