Doctors around the country are questioning whether aging men with declining testosterone should be medicated with hormone replacement therapy or if the concept of a male menopause is just another attempt to exploit the never-ending quest for the fountain of youth.
Men do start losing their peak testosterone levels beginning in their thirties, at a 1-percent to 2-percent drop per year, a downward slope significantly more gradual then the steep drop in hormones women experience when they hit middle age. Although no one is questioning whether to treat men who are testosterone deficient or lack the ability to produce this hormone on their own, physicians are wondering what to do about average, normal aging men who simply seem to be looking to renew their youthful vigor.
"The controversy is a little bit fabricated," Dr. Abraham Morgentaler, director of Men's Health Boston and a professor of clinical medicine at Harvard Medical School, told United Press International. "Some people object to this as if we're messing with Mother Nature, as if there's somebody out there and they already know what we're supposed to be like at every stage of their life."
Physicians and scientists long have been interfering with Mother Nature and for the last few decades, they also have been giving men testosterone, Morgentaler explained. "From cosmetics to coloring our hair to get rid of the gray to getting rid of heart disease to arthritic hip, to lowering cholesterol. Who's to say those aren't natural parts of aging?"
Testosterone deficiency is an under-recognized condition among men in the United States, said Morgentaler, who treats men from ages 18 to 85 suffering from low testosterone.
Loss of testosterone can lead to decreased muscle mass, lowered libido, and even additional body fat around the waistline. Improving testosterone levels can elevate libido, decrease fatigue and even boost physical energy levels, and it can also have a positive effect on mood, he explained. "No matter what their age, if they're the baby boomers turning 55 or if they're older men, it's worth treating them," he said.
Revving up testosterone levels even has been linked to increasing bone mineral density, which typically declines with age. Yet Dr. Frances Hayes, professor of medicine at Harvard Medical School and a reproductive endocrinologist, told UPI although testosterone may help men's bone mineral density in the spine, it does not do anything for the hip, where fractures are most likely to occur in older age.
"If you proposed testosterone was a treatment for aging, the market would be enormous," Hayes said. "But I don't think testosterone is magic bullet for aging."
Several men's health experts also cautioned there is some uncertainty whether long-term use of testosterone can actually thicken the blood and contribute to cardiovascular risks. There also is great concern testosterone therapy could stimulate the growth of an unidentified prostate tumor. Although testosterone does not appear to cause prostate cancer, if there is an existing tumor prior to therapy, testosterone replacement could aggravate the condition. Morgentaler said such men would need to have their prostate specific antigen levels, or PSAs -- a measurement for prostate cancer -- closely monitored.
"As far as we know in 2002, treating men with low testosterone of any age is safe and effective," he said.
That is what used to be said about estrogen and progestin replacement therapy for menopausal women, until this summer when several studies and subsequent headlines warned about the dangers of long-term use of the treatments. This prompted several scientists to call for clinical trials putting testosterone to the test before American men line up for their own hormone treatments. At present, there is little to no hard data upholding the benefits or affirming any risks of testosterone replacement therapy.
"I'm afraid people are going to get started on this and not know the benefits or the risks and they'll be on this for the rest of their lives," Dr. Alvin Matsumoto, a professor of medicine at the University of Washington in Seattle and at the Veterans Administration Puget Sound hospital, told UPI. Matsumoto said he has tried to get such a large clinical study going with help from the National Institutes of Health and the National Institute of Aging, which would have compared testosterone therapies to placebo, but lack of funding caused it to fall through. He said he is hopeful the project will be resurrected.
Dr. Wael Salameh, professor and endocrinologist at the University of California at Los Angeles Research Education Institute, said there is much to be learned from what happened with the women.
"There was a very big lesson that was learned from hormone replacement therapy in women," Salameh told UPI. "So I think based on this lesson, we should not embark giving hormone replacement therapy on men because it makes sense and the drug is already approved. So why not use it?"
He added, "I think there are individual practitioners who think that this is greatest thing there is and that we should give it ... to every person who fits that category, just try it out and see if it fits. I think these are people who are not waiting for the data."
There are testosterone therapies approved by the Food and Drug Administration, such as AndroGel, manufactured by Solvay Pharmaceuticals Inc. of Marietta, Ga. Androgel is approved for treating pituitary dysfunction but not for general application to men who feel they no longer have the energy they once did. Yet physicians are permitted at their own discretion to prescribe government-approved drugs and therapies for other ailments.
Where might this leave the estimated 13 million-plus men age 50 and older and the extremely large numbers of males from the baby boomer generation who also are looking to retain what was once theirs in their 20s and 30s? Experts said testosterone replacement therapy never will reach the numbers or become the norm as it did for middle-aged women.
"No one is proposing going ahead and grabbing older men and starting to treat them with AndroGel or anything else," Salameh said. But there is evidence some groups of men who show abnormally low testosterone levels could benefit from hormone replacement, he explained.
Morgentaler said he believes the numerous benefits of testosterone, which doctors have long known about, will catch on. "Because something hasn't been studied to the level we would like it to be doesn't mean there's a problem with it. It just means it hasn't been studied."
