Not All Men Will Need Testosterone Replacement Therapy
By Denise Mann
WebMD Health News
Latest Men's Health News
Reviewed by Laura J. Martin, MD
Dec. 2, 2011 (New York City) -- It may be called "men"-opause, but it's a time of life that only belongs to women. Male menopause, well, that may be a myth, according to some experts.
While many men and men's health experts argue that male menopause (andropause) occurs when a man's supply of the male sex hormone testosterone dwindles with advancing age, there really is no such thing, says Bradley Anawalt, MD, an endocrinologist at the University of Washington in Seattle. Anawalt spoke at a meeting sponsored by the Endocrine Society in New York City.
"When we use the term menopause with women, it refers to a precipitous fall in levels of the [female sex hormone] estrogen in three to five years as their ovaries stop functioning properly," he says.
It's a different situation with men. "There is a decline on average of 1% of testosterone per year starting at age 30," he says. "It is not a seminal event and doesn't occur in all men. Some men who are very healthy and virile do maintain their testosterone levels for longer periods of time."
To Treat Low Testosterone or Not to Treat It?
This is not to say that certain men with declining levels of testosterone can't benefit from testosterone replacement therapy. Who should be treated for low testosterone, and who should not is more of an art than a science, Anawalt says.
"Testosterone replacement therapy is viewed as the fountain of youth in men," he says. "Testosterone is not a [cure-all] for everything for everybody. There is clearly a segment of older men who will benefit from testosterone treatment, but this is not a universal truth and not all men should be on it."
"We have to look at 50- to 60-year-old men and say, 'Do they have symptoms and signs that suggest low testosterone?' And then we need to confirm with blood tests," he says.
Symptoms of low testosterone may include:
- Low libido
- Decreased sexual desire
- Decreased rigidity of an erection
- Reduced energy
- Decreased sense of well-being
- Brittle bones
- General weakness
Part of the problem is that it can be hard to accurately measure testosterone levels in the blood, Anawalt says.
Some men may have low levels of total testosterone but normal levels of so-called free testosterone, which is the hormonally active form. "We think these men are normal," he says.
Buyer beware, Anawalt says. "It's easy to get testosterone off the Internet or from people who have low standards for prescribing it. Many men are started for questionable reasons, and their dose keeps getting ratcheted up," he says.
Some doctors are also prescribing human chorionic gonadotropin (HCG) to stimulate testosterone production. HCG is sometimes used to treat women's fertility problems and is at the center of the controversial HCG diet.
"HCG should not be used for testosterone replacement," Anawalt says. "This raises a lot of red flags."
"The best thing men can do is not start testosterone therapy unless they have been fully evaluated by an endocrinologist or knowledgeable internist," he says.
Henry Anhalt, DO, an endocrinologist in Hackensack, N.J., agrees that the indiscriminate use of testosterone supplements is risky business.
"There is a role for testosterone replacement therapy in those who are evaluated by an endocrinologist and who understand the issues around lab testing," he says. "The abuse of testosterone in both older people and younger people is rampant. It could be very very dangerous.'
Risks may include:
Jed Diamond, PhD, contends that male menopause isn't a myth. "In my opinion, it is very real," he says. Diamond is the director of MenAlive, a male health program in Willits, Calif. He's also the author of Male Menopause and Surviving Male Menopause.
"The term itself is not literally accurate," he says. "Men don't have a menstrual cycle so they don't stop having one. Hormonal, physical, and psychological changes do occur in men at midlife."
"Testosterone is not something we do for every man," Diamond says. "Not all men need it or would benefit from it."
Other treatments including counseling may also help men cope with the symptoms of this time of life.
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