AGING PROCESS Jury is out on whether men need testosterone therapy

Despite the lack of scientific findings, the therapy is a booming business.
By KORKY VANN
HARTFORD COURANT
According to conventional wisdom, hitting middle age always meant menopause for women and midlife crisis for men.
These days, though, as millions of women are reassessing the use of estrogen out of concern regarding the increased possibility of cancer, heart attack and stroke, hundreds of thousands of U.S. men are seeking hormone treatment for declining sex drive, muscle and bone loss and other symptoms of "andropause," or "male menopause."
But in spite of the fact that testosterone replacement therapy sales hit $400 million in 2002 -- a demand that is expected to grow as male boomers look to slow down the aging process -- there is no consensus in the medical community that the condition exists and even less agreement that hormone therapy for men is an anti-aging magic bullet.
"In the past, the thought was that when women hit their 50s, they got hot flashes and when men reached their 50s, they got a Corvette," said Anne Kenny, assistant professor at the University of Connecticut Health Center's Center on Aging. "Now there is a great deal of interest in if and how a decline in testosterone contributes to physical and cognitive function as men age and whether testosterone replacement therapy offers health benefits or health risks. We don't have enough data to have a definitive answer."
Not comparable
For starters, comparing andropause to menopause is misleading, Kenny said. Women's estrogen levels begin to decline sharply as they hit their 40s and 50s. While there is a natural decline in testosterone as men age, the extent to which this drop contributes to such symptoms as fatigue, frailty, decline of virility and "losing one's edge" is unknown.
"These symptoms also can be associated with many other conditions, including diabetes, thyroid abnormality, depression and stress," said Kenny, who is conducting a study on the effects of testosterone therapy on bone loss in older men. "Most men don't have a true testosterone deficiency."
That lack of scientific knowledge hasn't stopped increasing numbers of middle-age men from requesting and getting prescriptions for testosterone replacement, especially since earlier hormone delivery methods such as injections and irritating skin patches have been replaced by easier-to-use gels.
Warns of risks
A 2003 report on the issue by the International Longevity Center-USA, an aging-issues think tank in New York, says the trend is the equivalent of a massive, uncontrolled and possibly life-threatening experiment.
"When a large number of people take unproven testosterone-replacement treatments, it creates a mass, nationwide, unregulated laboratory that will have unpredictable results for those involved," said Dr. Robert Butler, president and CEO of the longevity center. "Since the possible benefits are unproven and the negative side effects of prostate cancer and coronary issues are unknown, men should seriously question the risk/benefit ratio of this type of treatment."
The National Institute on Aging also has expressed concern about the use of testosterone-replacement therapy in the absence of sufficient scientific information about its risks and benefits.
"Testosterone therapy remains a scientifically unproven method for preventing or relieving any physical or psychological changes that men with normal testosterone levels may experience as they get older. Except for a relatively few younger and older men with extreme deficiencies, testosterone treatment is not deemed appropriate therapy for most men at this time," the institute said in a statement.
Alternative action
Men concerned about testosterone levels can request a blood test to determine if they have a true deficiency, Kenny said. But in most cases, symptoms can be resolved simply by moving more and worrying less.
"Baby boomers are looking for a magic pill or fountain of youth," Kenny said. "The reality is they can often get the effects they're searching for through reducing their stress levels and increasing their exercise."