Testosterone Therapy: Treatment for Male Menopause?
At about age 30, men begin to produce less testosterone (the main male sex hormone). Usually, production decreases an average of 1 to 2% a year. This decrease and its effects are less dramatic than the usually rapid, nearly universal hormonal changes that occur in women during menopause. Nonetheless, the decrease in testosterone production is sometimes called male menopause or andropause. How rapidly testosterone levels decrease varies greatly among men. Many men in their 70s have a testosterone level that matches that of the average man in his 30s.
Men with a low testosterone level may develop certain characteristics associated with aging. They may have a decreased sex drive (libido) or erectile dysfunction (impotence). They may have less muscle, more abdominal fat, porous bones that easily fracture (osteoporosis), and less energy. Complex mental tasks may take longer. The red blood cell count may be low, resulting in anemia. If the testosterone level is very low, breasts may enlarge, testicles may shrink, and pubic hair may be lost. Many men—regardless of their testosterone level—are interested in taking testosterone to slow or reverse these effects. But testosterone is helpful only if the testosterone level is abnormally low.
The most worrisome side effect of testosterone therapy is worsening of a prostate gland disorder. Testosterone can make prostate cancers grow. Consequently, it is not given to men with prostate cancer. However, many men have undiagnosed prostate cancer. So some doctors worry that testosterone therapy may make such a cancer grow. Testosterone can also worsen benign prostatic hyperplasia.
Testosterone therapy is recommended only for men who have a low testosterone level (determined by a blood test), who have symptoms of testosterone deficiency, and who do not have a prostate disorder. Usually, testosterone is applied as a gel or a patch or is injected. Men taking testosterone should be checked frequently for prostate cancer. Such testing may detect cancers early, when they are more likely to be cured.
