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Public release date: 03 June 2010
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The use of synthetic testosterone in 'male menopause' treatment is questionable
An article in Drug Therapeutics Bulletin, a BMJ (British Medical Journal) journal, based on fact it is not clear
whether
male menopause actually exists, and inconclusive evidence on testosterone's effectiveness in treating it,
concludes that the use of synthetic testosterone is questionable.
Previous studies showed
testosterone levels drop by approximately 1% to 2% annually from the age of 40 years in men,
while in women levels of estrogen take a nosedive during the menopause and production stops almost completely.
However, in males, testosterone production does not stop.
About 80% of 60 year-old males and half of 80 year-old males still have testosterone levels within the normal range
for younger men. The articles states that low levels of testosterone are not an inevitable consequence of ageing.
Neither do low testosterone levels in older men produce symptoms. Symptoms which are often attributed to low hormone
levels, such as low libido (sex drive),
erectile dysfunction, reduced physical strength, and low mood occur in a
significant number of males with normal hormone levels.
The evidence that an age-related drop in testosterone levels causes certain symptoms is not compelling; in fact it
is weak.
The article suggests these facts undermine the idea that a number or males develop a condition called late-onset
hypogonadism. This condition is sometimes known as the
male menopause or andropause.
The published evidence is also questionable on whether testosterone administered to older men with
hormone reduction helps symptoms, such as poor sexual function or depression. Even though there are suggestions that
testosterone therapy may moderately increase bone density and muscle strength, there is no proof of subsequently
reduced bone fracture risk or any worthwhile benefits.
The Drug Therapeutics Bulletin also informs
testosterone therapy also has some undesirable side effects, such as:
- A rise in PSA (prostate specific antigen)
- Blockage of the urinary tract
- Prostate cancer risk
- Gynecomastia (development of breasts)
- It may aggravate ischaemic heart disease, epilepsy, and sleep apnea
There are potential issues associated with the different ways of administering the hormone. For example:
- Patches may cause skin irritation
- Implants require minor surgery, which carries risks
- Gels can be unintentionally transferred to other people
Overall, Drug Therapeutics Bulletin sees only very limited scope for treating men with testosterone who have
low levels of the hormone related to age.
A main conclusion of the report says that clinicians should not offer testosterone therapy without explicit
discussion of the uncertainty about its risks and benefits in this population. There is no place for
testosterone therapy in older men without symptoms, or without clearly low testosterone concentrations
on more than one occasion.
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