MALE HORMONE THERAPY

It’s a litany of symptoms sure to push every button a middle-age man has:

Fatigue, loss of strength, decrease in bone density, increase in fat and–most frightening for some–diminished sexual drive and function. Who wouldn’t be depressed?–which also is a symptom of hypogonadism, or abnormally low levels of the male hormone testosterone.

For decades, women have been grappling with the question of whether to undergo hormone-replacement therapy, a topic that received broad attention as Baby Boomers began reaching menopause. Now, as men of the Baby Boom generation start turning 50 and patches that deliver testosterone make replacement more stable and convenient, similar attention is beginning to be paid to the male hormone.

Useful levels of testosterone might drop by as much as 30 percent to 40 percent between the ages of 50 and 70. Whether the decline that comes with age is significant and a clear signal of the need for treatment is not known.

Unlike menopause, in which levels of hormones drop rapidly, the decline of testosterone in men is gradual: an estimated 1 percent a year between a man’s late 40s and early 70s. Further complicating the question is the fact that men’s levels of testosterone vary widely: The range considered normal is anywhere from 300 to 1,200 nanograms per deciliter of blood.

Finally, not all men undergo the same drop in levels as they age, and even if testosterone does drop, researchers are unsure whether the benefits of replacement outweigh the risks for otherwise healthy men.

In other words, this is one area in which knowledge about women’s health far outstrips knowledge about men’s.

“Women are way ahead,” said Dr. Steven Petak, a Houston endocrinologist who headed a committee of the American Association of Clinical Endocrinologists that last year developed guidelines for treatment of low testosterone in adult men. When it comes to deciding whether advancing age is reason enough to consider testosterone replacement, Petak said, “That’s one of the major questions I want to have answered because I’m an aging Baby Boomer too.”

Testosterone, created in the testes, is the primary male hormone. It helps regulate the development and growth of male sex organs and other characteristics such as muscle mass and body hair and spurs sex drive.

Testosterone levels in the blood fluctuate throughout a man’s life–even throughout a man’s day. They generally peak when a man is about 20 years old and are usually highest in the early morning and lowest in the evening.

Abnormally low testosterone levels can be the result of a variety of problems. Viral infections such as the mumps can affect the testosterone-producing cells, as well as a variety of genetic syndromes. Problems with the hypothalamus or pituitary gland can result in low testosterone levels, as can radiation, injury to the testes and surgery.

Then there’s age-related testosterone decline.

The American Association of Clinical Endocrinologists has found “growing evidence . . . that some aging men have reduced production of testosterone associated with decreased libido, impotence, decreased growth of body hair, decreased muscle mass, increased risk of myocardial infarction (heart attack) and decreased bone mass in conjunction with osteoporosis.”

In addition, the group’s treatment guidelines state, short-term research studies of testosterone-replacement therapy have shown improved lean body mass, decreased LDL (the so-called bad cholesterol), improved libido and improved “well-being.”

This, however, does not mean that every man should slap on a testosterone patch at his 50th birthday party. Estimates of the number of men who might need treatment generally come from the pharmaceutical companies that make drugs to treat the problem.

Alza Corp. in Palo Alto, Calif., which makes the Testoderm patch, estimates about 1 million men might be affected; SmithKline Beecham of Philadelphia, whose product is the Androderm patch, estimates between 4 million and 5 million. Only a fraction of those men are receiving treatment.

“Patients who really require testosterone are relatively rare,” said Dr. S. Mitchell Harmon, chief of the section on endocrinology at the National Institute on Aging, where researchers generally have been cautious about the use of hormones. “The real issue is if the elderly are going to benefit, and that is unresolved.”

“There’s a lot more we need to know, and to jump in and say, `Gee, let’s treat all men with this’ is not right,” Petak said. “On the other hand, it could be that for elderly men with low levels of testosterone, this is an appropriate treatment.

“But I am not an advocate for shotgunning an entire population. We hit that with estrogen, and there were problems.”

More Top Picks Electric Fireplace