The Male Menopause Debate

A recent article in Drug and Therapeutics Bulletin warns doctors that it is unwise to give men testosterone for “male menopause.” Doing so may increase the risk of prostate cancer.

Talk show hosts have long blamed declining testosterone levels for the diminished sex drive and fatigue they call the “male menopause.” While a woman’s level of estrogen drops almost to zero after menopause, a man’s level of testosterone remains relatively stable. In fact, many men who reported symptoms were found to have normal levels of testosterone.

Some drug companies have begun suggesting that synthetic testosterone is the solution to the “male menopause.” However, a man’s level of testosterone diminishes only one to two percent per year, beginning at age forty. And, some men’s levels of testosterone do not diminish at all. About 80 percent of men aged 60 and older still have testosterone levels within the normal range for a 30-year old. Even more surprisingly, about 50 percent of men in their 80s still have high levels of testosterone.

The article urges physicians to test a man’s testosterone level repeatedly and only prescribe medication if it is consistently below normal. The number of men who suffer from hypogonadism  or chronically low levels of thyroid is small.

Despite drug company’s claims, there is little evidence that synthetic testosterone improves a man’s qualify of life. In clinical trials, it was not shown to improve mental functioning or depression. Evidence was inconsistent on how testosterone might affect a man’s weight, blood pressure or risk of diabetes.

Synthetic testosterone has been shown to increase risk of heart disease, epilepsy and migraines.

In one study of 228 men over 60, testosterone did not increase their satisfaction with their sex lives. In another study, men aged 60 to 80 were given treatment to suppress the production of natural testosterone, and treated with synthetic testosterone instead. Higher doses made it easier for the men to get an erection, but had no effect on the frequency of sex.

Consumer Reports notes that heart disease or cholesterol problems often cause erectile dysfunction, so this symptom should be carefully checked by a doctor. However, even if treatment is necessary, there are much more effective medications and lifestyle changes than taking synthetic testosterone.

By Joni Holderman, [email protected], contributing reporter for Mental Health News.