Testosterone to treat 'male menopause' questionable

Testosterone to treat 'male menopause' questionable

Given that it is not clear whether male menopause actually exists, and inconclusive evidence on testosterone's effectiveness in treating it, an article in today's Drug Therapeutics Bulletin (DTB), a BMJ (British Medical Journal) journal, says that the use of synthetic testosterone is questionable.

Testosterone levels drop by approximately 1% to 2% annually from the age of 40 years in men, while in women levels of estrogen take a nosedive during the menopause and production stops almost completely. In males, testosterone production does not stop, the DTB says.

About 80% of 60 year-old males and half of 80 year-old males still have testosterone levels within the normal range for younger men. The articles states that low levels of testosterone are not an inevitable consequence of ageing.

Neither do low testosterone levels in older men produce symptoms. Symptoms which are often attributed to low hormone levels, such as low libido (sex drive), erectile problems, reduced physical strength, and low mood occur in a significant number of males with normal hormone levels.

The evidence that an age-related drop in testosterone levels causes certain symptoms is not compelling; in fact it is weak.

These facts undermine the idea that a number or males develop a condition called late-onset hypogonadism, sometimes known as the male menopause or andropause, the article argues.

The published evidence is also questionable on whether testosterone administered to older men with low levels of the hormone helps symptoms, such as poor sexual function or depression.

Even though there are suggestions that testosterone therapy may moderately increase bone density and muscle strength, there is no proof of subsequently reduced bone fracture risk or any worthwhile benefits.

Testosterone therapy also has some undesirable side effects, the DTB informs, including:

  • A rise in PSA (prostate specific antigen)
  • Blockage of the urinary tract
  • Prostate cancer risk
  • Gynecomastia (development of breasts)
  • It may aggravate ischaemic heart disease, epilepsy, and sleep apnea
There are potential issues associated with the different ways of administering the hormone. For example:
  • Patches may cause skin irritation
  • Implants require minor surgery, which carries risks
  • Gels can be unintentionally transferred to other people
Overall, DTB sees only very limited scope for treating men with testosterone who have low levels of the hormone related to age.

The report states:

Clinicians should not offer testosterone therapy without explicit discussion of the uncertainty about its risks and benefits in this population. There is no place for testosterone therapy in older men without symptoms, or without clearly low testosterone concentrations on more than one occasion.

"Testosterone for late onset hypogonadism in men?"

DTB Vol 48; June 2010; 69-72

DOI: 10.1136/dtb.2010.01.0004

Dr. David Samadi - Male menopause & side effects of low testosterone (Video Medical And Professional 2020).

Section Issues On Medicine: Man's health

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