Harvard Medical School Newsletter

November 30, 2001

Yes, there may well be such a thing as male Andropause, but the malaise goes far beyond the so-called "midlife crisis" of popular culture. More specifically, the male version of Andropause is the gradual decline in the chief male sex hormone, testosterone, which in the average man begins as early as the third decade of life. Most men remain unaware of the decline, but researchers now believe that it may be associated with common age-related changes like high cholesterol, muscle weakness, weight gain, and heart problems

Q: Do men undergo something like Andropause as they age?

A: The term "male Andropause" is really something of a misnomer. What the average healthy man will experience as he ages is not a noticeable change, like female Andropause, but a gradual decline in the principal male sex hormone, testosterone. The decrease can begin in the late 30s, and by the 70s, blood levels may have dropped by one-third to one-half of the levels observed in young men.

We believe that this decline is linked to common age-related changes in healthy men, such as decreases in muscle tissue and bone mineral density, increases in abdominal body fat, a rise in cholesterol, and deteriorating heart function, as well as psychological and sexual changes. We know that such hormonal associations with aging exist for women, and we can treat them with replacement therapy. We also know that young men with severe testosterone deficiency suffer from muscle weakness, osteoporosis and psychosexual dysfunction, and that these problems lessen or disappear when such men are given a testosterone supplement.

Q: What research is currently being done in this area?

A: Three large NIH-funded human trials have recently been completed. The tabulated data will likely confirm and extend our beliefs about the role of testosterone decline and supplementation in healthy aging men. We expect some important findings will be published next year that will allow us to look at the aging process differently, and help us take a kinder, gentler approach to improving older men's quality of life.

Q: Can the decline be treated with hormone replacement, as with postmenopausal women?

A: Smaller studies have already suggested that very gradually replacing testosterone in selected healthy men can actually reverse some of the age-related problems of muscle weakness, osteoporosis, high cholesterol and others. For example, It may be beneficial for some men to begin receiving supplemental therapy while still in their 30s.

Q: Is there a chance that testosterone supplements could cause prostate disease?

A: Studies suggest that although testosterone is not a cause of new prostate cancer, it can contribute to the growth of existing prostate cancer. For their safety, men with this cancer were excluded from all the studies and we carefully and continually screened other participants for any sign of the disease.  However, it's our hypothesis that slow, gentle supplementation to help men return to their previous blood levels of testosterone is safe for men who are cancer free at the inception of  testosterone therapy.

Q: Are there other potential complications of testosterone supplementation?

A: We know that a man's cholesterol profile can worsen with too much testosterone. However, based on our investigations of men with deficiencies, we believe that slow, gentle supplementation can actually improve their condition, lowering the bad cholesterol and boosting the good.

Q: Can elderly men with other age-related illnesses benefit, or is the therapy limited to the healthy?

A: Elderly men who suffer from co-morbid conditions such as malnutrition, heart disease and diabetes mellitus also appear to have a more severe decline in testosterone than do healthy men. We believe they can gain particular benefits from supplementation, and researchers are starting to look at possible usefulness in diverse frail elderly populations. We hope that the therapy can prolong their independence and improve their quality of life.

I hope you will find our abstract  from the InteliHealth Newsletter interesting and informative.  Testosterone therapy should be considered in the larger concept of endocrine balance, the goal being the optimal range for a 30 y/o.  If testosterone is deficient there is a high probability that other hormone levels may also be deficient.

Information in this article is for educational purposes only, and is not intended as medical advice.

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