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Testosterone therapy: The answer for aging men?
By MayoClinic.com
More on this in Health & Fitness
* Men's Health Message Board
* Healthy Aging Message Board
* Men's Sexual Health Center
The possibilities are enticing: Increase your muscle mass, sharpen your memory and mental focus, boost your libido, and improve your energy level. If you're an older man, this may sound like the ultimate anti-aging formula. But such health benefits from testosterone therapy aren't quite so clear-cut.
Testosterone therapy has been used successfully for years to treat men with abnormally low testosterone levels — a medical condition called male hypogonadism. More recently, healthy, aging men have taken the hormone to boost waning testosterone levels. But not enough is known about the effects of testosterone therapy for this purpose. No long-term studies have weighed the potential benefits against the possible risks, including infertility and prostate problems.
Quote
Despite the lack of scientific evidence, testosterone therapy is growing in popularity. Pharmacies filled 2.2 million testosterone prescriptions in 2003 — twice the number filled in 2000, according to IMS Health, a company that tracks pharmaceutical sales. Though the number appears to be growing, there's no data that tracks who is filling these prescriptions — men or women — and for what purpose.
At the core of the controversy is whether gradually declining testosterone levels are a natural phenomenon or a health condition. And the practical question for men and their doctors is whether to treat it, particularly in the absence of scientific evidence. Before you buy into the tempting claims, find out what's known — and not known — about testosterone therapy so that you can make the best decision for you and your long-term health.
The natural decline of testosterone
Starting around age 40, a man's body produces about 1 percent less testosterone each year. Testosterone is the main male hormone that maintains muscle mass and strength, fat distribution, bone mass, sperm production, sex drive, and potency.
Image
The influence of testosterone in adult men
The influence of testosterone in adult men
The male hormone testosterone plays an important role in the development and maintenance of typical masculine physical characteristics. ...
Enlarge Image
Many call this progressive decline of hormones "male menopause" or "andropause" and equate it to women's menopause. But this isn't a valid comparison, says Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn. "In women, ovulation ceases and female hormone production plummets over a relatively short time frame," he says. "In men, there's a gradual decline in the production of male hormones."
For most men, testosterone levels naturally decline but still remain within the normal range throughout their lifetime, causing no significant problems. But about two in 10 men age 60 and older have testosterone levels below the normal range (testosterone deficiency).
Testosterone deficiency can have several effects on the body, including:
* Decreased energy
* Reduced muscle mass and strength
* Decreased cognitive function
* Less sexual interest or potency
* Depressed mood
If you experience these signs or symptoms, you may or may not have testosterone deficiency. Other medical conditions — such as liver disease, hypothyroidism and depression — can cause these effects as can certain medications, including beta blockers, pain killers and certain drugs for depression or anxiety. In addition, some healthy men encounter these changes as a part of the natural aging process, possibly because of declining hormones other than testosterone.
Talk to your doctor if you're experiencing these signs and symptoms. He or she can help determine the likely cause and suggest the best treatment plan, if any.
In hypogonadal men, testosterone therapy can restore sexual function and muscle strength and prevent bone loss. Also, some men taking testosterone therapy report an increase in energy, sex drive and well-being.
Some anti-aging enthusiasts claim that increasing the level of testosterone in older and healthy men provides these same benefits. Though potentially beneficial for some of these men, testosterone therapy isn't risk-free. High doses of testosterone may result in sleeping problems, infertility and excess blood production, which could increase the risk of stroke. Increasing testosterone levels may also pose problems for the prostate, a small male gland that produces most of the fluids in semen.
Testosterone naturally stimulates the growth of the prostate. Long-term testosterone treatment could cause benign prostatic hyperplasia (BPH) — enlargement of the prostate gland. Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present. This is especially worrisome since prostate cancer is common in older men, and many men have prostate cancer that isn't diagnosed.
To carefully weigh the potential pros and cons for you, consider the following:
Potential benefits Potential risks
* Improve muscle mass and strength
* Increase bone mineral density
* Thicken hair and skin
* Improve sex drive
* Boost energy
* Decrease irritability and depression
* Improve cognitive function
* Cause or aggravate sleep apnea (brief, repeated cessation of breathing during sleep)
* Stimulate noncancerous (benign) growth of the prostate and cause or worsen urinary symptoms
* Stimulate the growth of prostate cancer that's already present
* Enlarge breasts (gynecomastia)
* Limit sperm production
* Stimulate excess blood production (polycythemia)
* Cause acne
Men aren't the only ones evaluating the benefits and risks of hormone therapy. For years, women have wrestled with the decision whether to take hormone therapy for the treatment of menopausal symptoms. They've had to assess the pros and cons based on the available scientific evidence. Dr. Nippoldt says that men should learn from women's experience.
"Early studies suggested that taking hormone therapy might protect postmenopausal women from heart disease. But a large, long-term study found just the opposite results," he says. "We learned from these studies that we just can't predict all the potential harmful effects of taking hormones even though on the surface they may seem beneficial."
Who should take testosterone therapy?
Testosterone therapy is clearly beneficial for men whose testicles fail to produce sufficient levels of testosterone (hypogonadism). For this group of men, it can restore sexual function and muscle strength and prevent bone loss.
Few studies have evaluated possible benefits and risks of testosterone therapy for healthy, aging men. And those that have been done provide conflicting results. Many questions remain unanswered, particularly the extent and the duration of the beneficial effects, which men might benefit, and the possible long-term risks.
In November 2003, the Institute of Medicine (IOM) reviewed the current evidence surrounding testosterone therapy and reported that this treatment is only appropriate for men who produce little or no testosterone. The IOM concluded that the long-term effects of supplemental testosterone on otherwise healthy men aren't known. And until more studies have been done, the institute recommends that testosterone therapy not be used to prevent or relieve the physical or psychological effects of aging.
The debate continues
There's no question a man faces emotional and physical challenges as he gets older. Changes at home, at work and within his body all affect a man's general health. If you're concerned that you might have a hormone deficiency, talk to you doctor. A decline in testosterone that falls below normal values may be a reason to take supplemental testosterone. But it remains unclear whether restoring the testosterone levels to those of youth benefits older men.
By MayoClinic.com
More on this in Health & Fitness
* Men's Health Message Board
* Healthy Aging Message Board
* Men's Sexual Health Center
The possibilities are enticing: Increase your muscle mass, sharpen your memory and mental focus, boost your libido, and improve your energy level. If you're an older man, this may sound like the ultimate anti-aging formula. But such health benefits from testosterone therapy aren't quite so clear-cut.
Testosterone therapy has been used successfully for years to treat men with abnormally low testosterone levels — a medical condition called male hypogonadism. More recently, healthy, aging men have taken the hormone to boost waning testosterone levels. But not enough is known about the effects of testosterone therapy for this purpose. No long-term studies have weighed the potential benefits against the possible risks, including infertility and prostate problems.
Quote
Despite the lack of scientific evidence, testosterone therapy is growing in popularity. Pharmacies filled 2.2 million testosterone prescriptions in 2003 — twice the number filled in 2000, according to IMS Health, a company that tracks pharmaceutical sales. Though the number appears to be growing, there's no data that tracks who is filling these prescriptions — men or women — and for what purpose.
At the core of the controversy is whether gradually declining testosterone levels are a natural phenomenon or a health condition. And the practical question for men and their doctors is whether to treat it, particularly in the absence of scientific evidence. Before you buy into the tempting claims, find out what's known — and not known — about testosterone therapy so that you can make the best decision for you and your long-term health.
The natural decline of testosterone
Starting around age 40, a man's body produces about 1 percent less testosterone each year. Testosterone is the main male hormone that maintains muscle mass and strength, fat distribution, bone mass, sperm production, sex drive, and potency.
Image
The influence of testosterone in adult men
The influence of testosterone in adult men
The male hormone testosterone plays an important role in the development and maintenance of typical masculine physical characteristics. ...
Enlarge Image
Many call this progressive decline of hormones "male menopause" or "andropause" and equate it to women's menopause. But this isn't a valid comparison, says Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn. "In women, ovulation ceases and female hormone production plummets over a relatively short time frame," he says. "In men, there's a gradual decline in the production of male hormones."
For most men, testosterone levels naturally decline but still remain within the normal range throughout their lifetime, causing no significant problems. But about two in 10 men age 60 and older have testosterone levels below the normal range (testosterone deficiency).
Testosterone deficiency can have several effects on the body, including:
* Decreased energy
* Reduced muscle mass and strength
* Decreased cognitive function
* Less sexual interest or potency
* Depressed mood
If you experience these signs or symptoms, you may or may not have testosterone deficiency. Other medical conditions — such as liver disease, hypothyroidism and depression — can cause these effects as can certain medications, including beta blockers, pain killers and certain drugs for depression or anxiety. In addition, some healthy men encounter these changes as a part of the natural aging process, possibly because of declining hormones other than testosterone.
Talk to your doctor if you're experiencing these signs and symptoms. He or she can help determine the likely cause and suggest the best treatment plan, if any.
In hypogonadal men, testosterone therapy can restore sexual function and muscle strength and prevent bone loss. Also, some men taking testosterone therapy report an increase in energy, sex drive and well-being.
Some anti-aging enthusiasts claim that increasing the level of testosterone in older and healthy men provides these same benefits. Though potentially beneficial for some of these men, testosterone therapy isn't risk-free. High doses of testosterone may result in sleeping problems, infertility and excess blood production, which could increase the risk of stroke. Increasing testosterone levels may also pose problems for the prostate, a small male gland that produces most of the fluids in semen.
Testosterone naturally stimulates the growth of the prostate. Long-term testosterone treatment could cause benign prostatic hyperplasia (BPH) — enlargement of the prostate gland. Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present. This is especially worrisome since prostate cancer is common in older men, and many men have prostate cancer that isn't diagnosed.
To carefully weigh the potential pros and cons for you, consider the following:
Potential benefits Potential risks
* Improve muscle mass and strength
* Increase bone mineral density
* Thicken hair and skin
* Improve sex drive
* Boost energy
* Decrease irritability and depression
* Improve cognitive function
* Cause or aggravate sleep apnea (brief, repeated cessation of breathing during sleep)
* Stimulate noncancerous (benign) growth of the prostate and cause or worsen urinary symptoms
* Stimulate the growth of prostate cancer that's already present
* Enlarge breasts (gynecomastia)
* Limit sperm production
* Stimulate excess blood production (polycythemia)
* Cause acne
Men aren't the only ones evaluating the benefits and risks of hormone therapy. For years, women have wrestled with the decision whether to take hormone therapy for the treatment of menopausal symptoms. They've had to assess the pros and cons based on the available scientific evidence. Dr. Nippoldt says that men should learn from women's experience.
"Early studies suggested that taking hormone therapy might protect postmenopausal women from heart disease. But a large, long-term study found just the opposite results," he says. "We learned from these studies that we just can't predict all the potential harmful effects of taking hormones even though on the surface they may seem beneficial."
Who should take testosterone therapy?
Testosterone therapy is clearly beneficial for men whose testicles fail to produce sufficient levels of testosterone (hypogonadism). For this group of men, it can restore sexual function and muscle strength and prevent bone loss.
Few studies have evaluated possible benefits and risks of testosterone therapy for healthy, aging men. And those that have been done provide conflicting results. Many questions remain unanswered, particularly the extent and the duration of the beneficial effects, which men might benefit, and the possible long-term risks.
In November 2003, the Institute of Medicine (IOM) reviewed the current evidence surrounding testosterone therapy and reported that this treatment is only appropriate for men who produce little or no testosterone. The IOM concluded that the long-term effects of supplemental testosterone on otherwise healthy men aren't known. And until more studies have been done, the institute recommends that testosterone therapy not be used to prevent or relieve the physical or psychological effects of aging.
The debate continues
There's no question a man faces emotional and physical challenges as he gets older. Changes at home, at work and within his body all affect a man's general health. If you're concerned that you might have a hormone deficiency, talk to you doctor. A decline in testosterone that falls below normal values may be a reason to take supplemental testosterone. But it remains unclear whether restoring the testosterone levels to those of youth benefits older men.
