Should Men Take Hormone Replacement Therapy?

Clifton Cormier, a retired truck driver in Houston, decided he felt more tired than usual so he went to his doctor for a physical check-up.

“I was having problems with my memory and everything else, and my muscles were shrinking,” recalls Cormier, 78.

His doctor ran several blood tests and discovered that the testosterone level in his blood was low. The doctor referred him to Robert S. Tan, M.D., associate professor of family practice and community medicine at The University of Texas Medical School at Houston. Tan has had special training in geriatric medicine providing medical care for the elderly.

Tan recognized Cormier’s problems as typical symptoms of hypogonadism, also known as andropause. The term “andropause” means pause or cessation in the production of androgens, a group of hormones that includes testosterone. Sometimes it is called “male menopause.”

Tan put Cormier on testosterone replacement therapy, and the improvement in his muscle mass and energy level so impressed Cormier’s middle-aged son, Clifton I. Cormier, that his son also got tested. Clifton I.’s testosterone levels were low, so he began testosterone treatment, too.

“I don’t see a terrible decline in myself,” says Clifton I., 54, “but I want to prevent it.”

“About one in three men at some point in time have some kind of andropausal symptoms,” Tan says. Just as the hormone estrogen can decline in women undergoing menopause, so can testosterone decline in men as they age, he says. In men, though, the decline in hormones is much more gradual, occurring over a period of several decades.

In a study of 302 men Tan conducted in Texas, he found that male testosterone levels begin falling around age 40.

“It starts falling around 40, but age 50 or 60 is when they feel the effects,” he says. “Some people may dismiss the symptoms altogether or may not pay attention to them, but if you ask them directly, a lot of them say, ‘Yes, I’ve had those things coming on.’”

While medical literature has been documenting the phenomenon of andropause since the 1940s, Tan says more research is needed on how low testosterone levels affect men. To help men (and women) understand more about it, he has written a book, “The Andropause Mystery: Unraveling Truths about the Male Menopause.”

In the book, Tan describes these andropause symptoms:

• impotence or erectile dysfunction, which is the most common symptom,
  
• weakness, especially muscle weakness, possibly due to loss of muscle mass,
  
• memory loss,
  
• emotional intimacy problems,
  
• hot flashes, which occur only in approximately 1 in 10 men,
  
• osteoporosis, which is the weakening or loss of bone mass,
  
• hair loss in armpits and genital area, and
  
• shrinkage in size of sexual organs.
  

Testosterone replacement therapy should not routinely be considered a treatment for erectile dysfunction, Tan says.

“There are better treatments for that, including Viagra. Where testosterone replacement can help is with libido, or sexual desire. If you’re having erectile dysfunction because of low libido, testosterone increases your drive because it signals the brain.”

Tan stresses that the role of hormone replacement for men is not just the sexual aspect.

Quality-of-life issues are the main reason for considering testosterone replacement, he says, because it can improve memory, muscle strength, and mood and help preserve a man’s ability to function in daily activities.

Testosterone replacement therapy is only for men who are deficient in the hormone and have symptoms, Tan says. A total testosterone blood level of less than 300 nanograms per deciliter is considered low. However, the most important measure indicating whether or not to prescribe testosterone is the level of free testosterone in the blood.

The hormone can be taken as an injection once every two weeks, in pill form, or as a gel or a patch applied to the skin. The gel and the patch are more expensive than the injections but are more easily administered.

Men who take testosterone replacement therapy should have their Prostate Specific Antigen, or PSA, levels monitored closely by their physicians, Tan says, because if they have underlying prostate cancer, testosterone could conceivably help spread the cancer. Also, men with heart disease should carefully discuss with their doctors the risks of taking testosterone because it can thicken the blood.

For Clifton Cormier, the benefits of the therapy are worth it. He no longer thinks his memory loss and muscle weakness are a natural part of the aging process.

“Life has improved a whole lot,” he says. “Testosterone therapy has improved my mental capacity, and energy-wise it’s bringing my muscle tone back. I have a much better outlook on life.”

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©2006 Texas Medical Center

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