Every woman eventually goes through menopause, but there’s hot scientific debate about whether men experience a comparable hormonal upheaval as they age—a male version of menopause—and if so, how many men are affected. Although men’s levels of the male hormone testosterone do fall as they get older, many men don’t notice any difference, and two recent scientific papers came up with wildly different numbers for many men who experience troublesome symptoms due to waning hormone levels.
Last year, a British study published in the New England Journal of Medicine found that late-onset hypogonadism (aka male menopause or age-related testosterone deficiency) is real, but rare, affecting only 2.1 percent of the 3,219 middle-aged and elderly men studied. In July, however, another research team, including Harvard urologist Abraham Morgentaler, MD, reported in American Journal of Medicine that based on a review of previous research, about 30 percent of men ages 40 to 79 are afflicted with testosterone deficiency (TD), with rising rates strongly linked to both aging and such common disorders as diabetes, high blood pressure, obesity, and metabolic syndrome (a dangerous cluster of heart attack risk factors). To find out more about the controversy, I interviewed Dr. Morgentaler.
What is “male menopause?” The term ‘male menopause’ is problematic because men obviously don’t menstruate,” says Dr. Morgentaler, author of “Testosterone for Life,” (McGraw Hill, 2009). “However, the menopause analog fits because there is a clear decline in sex hormones with age (testosterone in men, estrogen in women), and the symptoms resolve with treatment of the deficiency.” The British study defined late-onset hypogonadism as a combination of age-related testosterone deficiency and three sexual symptoms: a decrease in morning erections, fewer sexual thoughts, and erectile dysfunction (ED). However, the researchers acknowledge that age-related testosterone deficiency remains a controversial diagnosis.
Does testosterone deficiency cause non-sexual symptoms? The British study found that chronic fatigue, sadness, loss of energy and stamina (making men unable to walk very far or participate in vigorous sports), and diminished flexibility were common among men with low testosterone. Along with these symptoms, Dr. Morgentaler’s patients with TD typically notice loss of strength, and increased body fat. “A significant percentage of these men are also at risk for osteoporosis (brittle bones that lead to fractures later in life), since testosterone is good for men’s bones, just as estrogen is good for women’s bones.” Other low T troubles can include insomnia and even hot flashes.
Testosterone: How low is too low? The British researchers found that men with a total testosterone level below 11 nanomoles per liter (as measured in a blood test) and a free testosterone level below 220 picomoles per liter had significantly more sexual symptoms than men with higher levels. Although the researchers recommended that these T levels be used to diagnose late-onset hypogonadism in men who also have three sexual symptoms, Dr. Morgentaler points out that there’s no medical consensus on “what threshold should be used for the blood test.”
Which men should consider having their T level checked? Dr. Morgentaler advises being tested for TD if you have symptoms of low libido, chronic fatigue, non-major depression, and ED. (Men should never dismiss ED as a sign of aging - it’s now considered a warning sign of heart disease, especially in men under 50.) Low testosterone is also more common among men with diabetes, affecting between 40 and 50 percent of all patients, Dr. Morgentaler adds. The blood tests should include both total and free testosterone. (It’s important to have this test in the morning when testosterone levels are highest).
What’s the treatment for low T? The treatment for low testosterone sounds simple enough: replace what’s missing. Testosterone therapy can restore a lagging libido and is said to be good for lots of other things: bone strength, energy levels, memory lapses, and dwindling muscle mass. Testosterone replacement is available as injections given every two or three weeks, daily applications of a skin patch and a gel to be rubbed into the skin. Pills don’t work because they don’t raise hormone levels high enough and aren’t a good idea anyway because they can lead to liver problems.
What’s the downside of testosterone therapy? Replacement therapy does pose some uncommon, but concerning risks, including:
Can testosterone therapy increase cancer risk? Conventional medical wisdom has held that hormone treatment may stimulate the growth of prostate cancer that is already present but doesn’t actually trigger the disease. New findings published this year by Dr. Morgentaler and others suggest that low testosterone may actually worsens prostate cancer and that testosterone replacement has no effect on untreated prostate cancer.
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