With all the controversies surrounding hormone replacement therapy (HRT) to address the health concerns of menopausal women, I’m sure there are some who might have the misconception that mid-life hormonal change is exclusively a women’s issue. But that’s not the case at all.
Today we’ll turn our attention to the men. Because men also face challenges to their health and well-being as they experience their own hormonal changes, sometimes known as andropause, or ‘male menopause.’
But much like we’ve seen in so many reports on female HRT, some disturbing questions were raised last month with the release of a new report that reviews the existing research on the safety and effectiveness of testosterone replacement therapy (TRT).
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.
For those men 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.
There is also prescription-only testosterone replacement therapy 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 a previous e-Alert I told you about a campaign to promote andropause as a condition requiring medical treatment. That campaign has been aggressively advanced by Unimed, makers of AndroGel, a testosterone replacement therapy formula that’s rubbed on the shoulders daily. AndroGel dominates the testosterone replacement therapy market of testosterone gels, creams and patches.
Not going long
Last month, a committee of the Institute of Medicine concluded a one-year review of existing testosterone replacement therapy research. They found only 3 trials that focused on older men. Most of those trials used less than 50 subjects, all but one lasted less than a year, and many were not placebo-controlled.
In light of the quickly growing testosterone replacement therapy market, the committee determined that the risks and benefits of testosterone replacement therapy 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 testosterone replacement therapy.
In addition, the committee recommended careful planning for upcoming trials in order to assess how testosterone replacement therapy 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 testosterone replacement therapy.
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 testosterone replacement therapy 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. So short-term studies will likely benefit manufacturers while potentially causing problems for users down the road.
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 testosterone replacement therapy. But the use of this therapy as an anti-ageing tool is scientifically unproven. In fact, committee chair Dr Dan G. Blazer, told WebMD Medical News that, ‘the evidence is almost nil.’ So in many ways, our knowledge of testosterone replacement therapy 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 testosterone replacement therapy: 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 ageing 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 40-something or older man who’s noticed changes in energy levels, sexual desires, or moods, share your concerns with your doctor.
But most importantly, weigh your options carefully before deciding which course to take.
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