The male analog to menopauseor andropausehas been associated with menopausal-like symptoms, including weakened bones, decreased sex drive, and even hot flashes and irritability. More and more men are asking their doctors for testosterone replacement therapy (TRT) prescriptions to alleviate some of these symptoms. But is TRT a safe and effective treatment for age-related declines in testosterone? And which menif anyshould be taking it?
Testosterone is one of the male sex hormonesor androgensresponsible for the development of masculine characteristics. During puberty, testosterone initiates the enlargement of the penis and testes, growth of facial and pubic hair, deepening of the voice, increases in muscle mass and strength, and growth in height. In male adults, testosterone is involved in the maintenance of sex drive, production of sperm cells, male hair patterns, muscle mass, and bone mass.
As men age, their production of testosterone naturally declines. But this age-related hormonal decline is much less dramatic in men than in women. During menopause, the production of estrogen and progesterone decreases sharply in women. The drop in testosterone is much more subtle in men.
Age-Related Changes in Men Low levels of testosterone have been associated with weakened bones, increases in diabetes and cardiovascular disease rates, diminished sex drive, and muscle loss in aging men. Signs of low testosterone levels include decreased sex drive, erectile dysfunction, low sperm count, reduced fertility, and increased breast size. Some men may even experience menopausal-like symptoms, including hot flashes, irritability, difficulty concentrating, and depression . If your doctor suspects your testosterone levels are low, a simple blood test can check it. But since testosterone levels fluctuate widely throughout the day, a single test may not be able to diagnose testosterone deficiency. Generally, the acceptable range of levels is between 300-1,200 nanograms per deciliter (ng/dl) for total testosterone. While testosterone does decline with age, diseases and conditions of the testes, pituitary gland, hypothalamus, and various genetic conditions may also cause reductions in the production of testosterone. If your testosterone levels are abnormally low, your doctor may perform additional tests to look for damage to the testes, or hypothalamic or pituitary gland diseases. If one of these diseases or conditions is detected, treatment may resolve the testosterone deficiency, or TRT may be indicated. In addition, some medications may cause the testosterone level to drop. Diminished testosterone levels are a known complication of chronic opioid therapy for chronic pain. If you take medications like morphine, oxycodone, fentanyl, or methadone for longer than six months, you should have your testosterone levels checked periodically.
Testosterone Replacement Therapy (TRT) The Food and Drug Administration (FDA) has approved four delivery methods of TRT for clinically low testosterone levels in otherwise healthy men: pills, injections, transdermal (through the skin) patches or gels, and a tablet that adheres to the gum surface. TRT has been shown to benefit men who suffer the symptoms of low testosterone in a number of ways, including: Increasing sex driveRestoring erectile functionImproving moodMaintaining beard growthIncreasing bone densityIncreasing muscle mass For years, menopausal women took hormone replacement therapy (HRT, a combination of estrogen and progesterone) to relieve symptoms of menopause and increase bone density. But recent findings from the Womens Health Initiative (WHI) trial have linked HRT with increased risk of breast cancer , heart disease , stroke , and blood clots. Interestingly, studies reported in 2005 suggested that testosterone may protect some men against the risk of atherosclerosis , a condition that often leads to heart disease and/or stroke. As of yet, there have been no long-term clinical trials testing the safety and effectiveness of TRT in men. However, as more and more men are getting prescriptions for TRT, more research is necessary. There are concerns that TRT may increase the risk of sleep apnea (interruptions in breathing while asleep), prostate enlargement , and prostate cancer, but only a large, randomized, controlled trial can effectively evaluate the risks and benefits of TRT.
Researchers did study whether TRT helps healthy, older men with low testosterone levels. Overall, patients taking testosterone therapy didnt experience improvements in important outcomes, like cognitive function and mobility and strength.*If you are considering this therapy, talk to your doctor about the potential harms and benefits. RESOURCES: The Endocrine Society http://www.endo-society.org/ National Institute on Aging http://www.nia.nih.gov/ References: Barrett-Connor E. Andropause and intima media thickness. J Am Coll Cardiol. 2005;45:1609-1610. Daniell HW. DHEAS deficiency during consumption of sustained-action prescribed opioids: evidence for opioid-induced inhibition of adrenal androgen production. J Pain. 2006;7:901-907. Daniell HW, Lentz R, Mazer NA. Open-label pilot study of testosterone patch therapy in men with opioid-induced androgen deficiency. J Pain. 2006;7:200-210. Hijazi RA, Cunningham GR. Andropause: is androgen replacement therapy indicated for the aging male? Annu Rev Med. 2005;56:117-137.
Patients guide to low testosterone: 2003 edition. Endocrine Society. Medical Library website. Available at: http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZO7PDVDLC&sub_cat=57 . Accessed May 21, 2007. Scientific task force to examine usefulness of testosterone replacement therapy in older men. National Institute on Aging website. Available at: http://www.nia.nih.gov/news/pr/2002/1106.htm . Accessed May 21, 2007. Testosterone test. American Association for Clinical Chemistry website. Available at: http://www.lagtestsonline.org/understanding/analytes/testosterone/test.html . Accessed November 6, 2003. Vastag B. Many questions, few answers for testosterone replacement therapy. JAMA. 2003;289:971-972. WHI findings. Womens Health Initiative website. Available at: http://www.whi.org/findings/default.asp . Accessed November 10, 2003. *1/21/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Emmelot-Vonk MH, Verhaar HJ, Nakhai Pour HR, et al. Testosterone therapy in older men with low testosterone levels. JAMA. 2008;299:39-52.
Last reviewed May 2007 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.