Testosterone Replacement Growing in Popularity

Call it andropause or just call it male menopause, but whatever you call it, it’s very real for some men. The fatigue, the depression, the impaired memory, the low libido and, yes, even the hot flashes are symptoms that men may experience when testosterone levels sink.

“I mean, really?” skeptical women in their 50s may ask, and Laurence M. Solberg, MD, understands their incredulity. Women, Solberg said, have a “physiologic change” that can be drastic and even debilitating. “To call it menopause and compare it to what women go through is probably slighting the women,” said the chief of the Geriatrics Consult Service for Vanderbilt University Medical Center in Nashville. “Unlike women, there is no time frame that males have a definite drop-off of their testosterone production. You’ve probably heard stories and seen in the news about men fathering children when they’re in the later ages, in their 70s and 80s even. There was a report of a gentleman who was 100 and fathered a baby.”

Nonetheless, the gradual loss of testosterone clinically affects some men, Solberg acknowledged, and hormone replacement is the solution.

Jeffrey Donohue, MD, a family practitioner who practices anti-aging medicine in Atlanta, acknowledged that “guys don’t really want to talk about it too much, but they are seeing and hearing about it more often.” So are internists, family practitioners and other physicians who treat adults. Nonetheless,
Donahue said, there still aren’t enough physicians who think about low testosterone as a cause for patient fatigue, depression and other symptoms common with declining hormone production.

John E. Morley, MD, an endocrinologist and geriatrician who heads the Division of Geriatric Medicine at Saint Louis University School of Medicine, developed a questionnaire to help doctors and patients decide whether a testosterone test might be needed. The screening tool is called ADAM (Androgen Deficiency in Aging Males), and the questions are:

1.      Do you have a decrease in libido (sex drive)?

2.      Do you have a lack of energy?

3.      Do you have a decrease in strength and/or endurance?

4.      Do you have lost height?

5.      Have you noticed a decreased “enjoyment of life”?

6.      Are you sad and/or grumpy?

7.      Are your erections less strong?

8.      Have you noticed a recent deterioration in your ability to play sports?

9.      Are you falling asleep after dinner?

10. Has there been a recent deterioration in your performance at work?

It has been proven clinically that answering “yes” to No. 1 or No. 7 or any three of the other questions can indicate a testosterone deficiency.

Donohue treats about 30 male patients a day in his anti-aging practice, which is associated with BodyLogicMD, a network of physicians who specialize in bioidentical hormone therapy for both men and women. Donohue also specializes in custom nutrition and fitness programs for his patients.

BodyLogicMD touts “natural” bioidentical hormones, which the company says “are derived from naturally occurring sources, such as yams and soy, and are designed to replicate the same chemical structure as the hormones that are produced naturally by our bodies. Based on your hormone levels, a specialized compounding pharmacy can individually tailor a bioidentical hormone regimen specifically designed for you.”

Donahue said his interest in anti-aging medicine and natural hormones started with the Women’s Health Initiative and the researchers’ decision in 2002 to halt a trial of women taking estrogen plus progestin because of health risks identified during the study. That’s when Donohue and a friend who is a compounding pharmacist joined forces.

There’s a misconception, Donohue said, that testosterone replacement causes prostate cancer, and there’s “no question,” he added, that that belief is prompted by the research linking estrogen plus progestin with breast cancer. “Testosterone does not cause prostate cancer. If you have prostate cancer, we don’t give you testosterone. It will never turn a cell that is normal into a cancer cell,” he said.

Solberg concurred, explaining that prostate cancer cells “are fed” by testosterone, but not caused by it. Solberg uses synthetic hormone replacement in his practice and is not a fan of the bioidentical variety because it isn’t approved by the federal Food and Drug Administration. He said creams are the delivery method of choice for most of his patients, although some prefer shots.

Just how quickly can a patient experience relief after hormone therapy begins? “Usually, if their testosterone level is sufficiently declined and they are having physical, clinical symptoms, when they start the replacement therapy, they feel wonderful in probably three weeks. It can be that quick,” Solberg said.

To determine low testosterone, physicians should test for a serum-free testosterone level. “Don’t get stuck on just checking totals,” Donahue said. “You have to check the components.”

Solberg said research has shown that testosterone replacement for men who aren’t deficient has no effect when compared with a placebo. “It’s really only for that group that honestly has a low testosterone level,” he said. Research has also shown that testosterone deficiency is a cause for osteoporosis in men, just as estrogen deficiency causes bone loss in women.

“Many studies have also shown that, when men have heart attacks, the ones who have higher testosterone are more likely to survive and recover faster,” Donahue added. Research to date hasn’t documented whether testosterone replacement has adverse side effects.

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