Male Menopause, Does Testosterone Replacement Benefit?

For decades, older women have taken hormone replacements to replenish estrogen and progesterone levels lost to aging, called Menopause. We have learned during the years that hormone replacement can be beneficial but not without risk for the stimulating effects of the hormones. Long term use (>5 yrs) is therefore advised in general for women. More recently, testosterone (the most important male hormone) supplements have been used by aging men to improve their quality of life, Male Menopause or Andropause has been described as the male decline in testosterone levels. In 2003, the number of elderly American men taking testosterone replacement therapy was already 1 million, and the number has been growing faster in recent years. Lets have a look at the current studies on effect and safety.

Testosterone and its Effects

 

It’s not clear that naturally falling testosterone levels cause any signs and symptoms in men. Studies of men who have very low levels of testosterone due to diseases and treatments may offer some clues to the role testosterone plays in a man’s body as he ages. According to those studies, testosterone deficiency can have several effects on the body, including: Decreased sexual function , Loss of bone density, Loss of muscle mass, Increase in fat mass, Reduced muscle strength, Memory loss, Mood changes and depression.

Potential benefits Potential risks
Improve muscle mass and strengthCause skin reactions
Increase bone mineral densityCause fluid retention
Thicken body hair and skinCause baldness
Improve sexual desireStimulate noncancerous growth
of the prostate and cause urinary symptoms
Boost energyCause testicle shrinkage
Decrease irritability and depressionCause acne
Improve cognitive functionStimulate growth of prostate cancer that’s already present
Stimulate blood productionEnlarge breasts
table: pro's and cons of using testosterone supplement

Some men experience these signs and symptoms, but don’t have unusually low levels of testosterone. Others may have low levels of testosterone, but don’t experience any signs and symptoms that would prompt them to seek treatment.

Testosterone replacement therapy can help older men deficient in the hormone reduce their risks of heart disease, diabetes, and death, according to new research presented at the annual meeting of The Endocrine Society.

The goal of testosterone treatment is to keep the levels within normal range. Low levels of testosterone are common with age, occurring in about 20% of 70-year-olds. Low levels of testosterone are associated with the metabolic syndrome — a cluster of risk factors such as abnormal cholesterol and high blood pressure that boost risk of heart disease, stroke, and type 2 diabetes as well as other risks to health.

The Studies found that testosterone replacement therapy reduced the metabolic syndrome risk factors and did so in a similar way in all the age ranges studied.

Testosterone Replacement Therapy and Heart Disease Risks

In the first study 95 men, aged 34 to 69, with low levels of testosterone were included.
All had metabolic syndrome. Those who have this diagnosis must have three of five risk factors: increased waist circumference, low “good” cholesterol or HDL, high triglycerides, elevated blood pressure, and elevated blood sugar.

They were treated for at least a year. Every three months, they measured cholesterol, waist circumference, and other parameters.

The testosterone replacement was given as a long-acting injection (Nebido), every three months. The men were not given a special diet or exercise program.

The supplemental testosterone reduced total cholesterol, “bad” LDL cholesterol, triglycerides, and body mass index while improving “good” HDL cholesterol. The men lost their pot bellies, appr. three or four inches off the waist, and a reduction by one-fourth to one-third of their total cholesterol. No adverse effects were reported.

Testosterone Replacement Therapy: No Age Effects?

In a second study, the same 95 men were divided into three groups, based on age: less than 57, 57 to 63, and older than 63.

They found the older men and the younger men had similar improvement in their risk factors.

Precautions with testosterone supplementation

It is well known that with prostate cancer, the cancer is usually dependent on testosterone. Prostate cancer is a slow-growing tumor. Cancer must be ruled out before starting supplements, and routine prostate checkups are advised.

A test to monitor red blood cell formation, called a hematocrit, is needed, too. The potential increase in red blood cells, can theoretically boost heart attack or stroke risk.

Testosterone and Death Risk

Low testosterone levels are associated with an increased risk of death, according to Robin Haring, a researcher from Germany.He evaluated data on nearly 2,000 men, aged 20 to 79, following them for seven years until August 2007. He noted testosterone levels, age, weight, smoking habits, and physical activity. During the follow-up, 226 men died. Men with low testosterone have a more than twofold higher risk of death during the follow-up period.

They were more likely to die of cardiovascular disease and cancer, but not of other causes.

Testosterone Replacement Therapy: Long-Term Effects Unknown

The problem area  about supplemental testosterone is the lack of knowledge on long-terms effects. Testosterone [in excess] can increase blood pressure and compromise kidney function. These problems can be seen with bodybuilders using large doses of testoterone or an equivalent derivative. If health risks with the low supplementation to “natural” levels can induce similar problems has not be seen yet in studies, sideeffects were not significant but patients were also filtered on possible prostate problems. With influx of new ways of taking TRT we wonder how this market will develop. Low testosterone levels are not [yet] indicated as a disease so reimbursement by insurance is nill. Dermal patches and gels and (long acting) injections range in price between $20 – 200 monthly excluding the tests and consultation fees.  Allthough the studies show that restoring testosterone when it is low improves metabolic syndrome factors and could help prevent type 2 diabetes and cardiovascular risks as with other therapies lifestyle changes can also have a significant effect on the hormone levels and the mentioned risk factors, especially the good old watch what you eat (and how much) and exercise !