Experts are convinced men go through an equivalent of the menopause blaming a drop in testosterone in middle-age
As we get older, the levels of our sex hormones decline. In women, this leads to the menopause. But do men go through a male equivalent as their testosterone drops?
Some experts — and men themselves — are convinced they do, blaming a drop in testosterone for a host of middle-age problems, from low energy and poor concentration to man boobs, irritability and impotence.
Indeed, they believe that many men, perhaps one in five over-50s, should have testosterone treatment to restore their vigour and well-being.
In fact, this male hormone replacement therapy (HRT) is gaining ground and, over the past decade, prescriptions for testosterone gels and injections have doubled, to 300,000 a year.
But the idea of a male menopause is the subject of furious debate.
Hormone experts insist the rising popularity of male HRT simply reflects aggressive marketing by the pharmaceutical industry. In the U.S., where drug companies can advertise directly to the public, men spend nearly £2.5 billion a year on testosterone. This is despite the lack of data on its long-term safety, and the fact that symptoms don’t always improve, says Dr Richard Quinton, consultant endocrinologist at the Royal Victoria Hospital in Newcastle upon Tyne.
For most men, the symptoms attributed to low testosterone and the male menopause are actually ‘normal symptoms of unhealthy ageing’, says Professor Fred Wu, director of the Andrology Research Unit in Manchester.
In other words, low testosterone suggests that you haven’t being looking after yourself.
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Professor Wu points out that obese men with low testosterone normally find their levels bounce back when they lose weight. ‘It’s the same when patients control their diabetes,’ he says. Other factors that can affect testosterone levels include depression and excessive drinking, adds Professor Gary Wittert, head of medicine at the University of Adelaide, Australia.
‘Low testosterone is usually — though not always — caused by changes in a man’s physical and mental health and lifestyle that commonly occur as they age.’
Male hormone replacement therapy (HRT) is gaining ground and, over the past decade, prescriptions for testosterone gels and injections have doubled, to 300,000 a year
There is also the tricky question of what level of testosterone is ‘unhealthy’.
Levels can vary within the day, and over a lifetime. The ‘normal’ range can be anything from 10.4 to 41.6 nmol/l (nanomoles per litre of blood).
‘It’s virtually impossible to say what is a healthy level of testosterone,’ says Marian O’Connor, a senior lecturer in psychosexuality at the Tavistock Centre for Couple Relationships in London. ‘A man can be healthy and sexually active while having a relatively low testosterone level.’
Experts say switching to a healthy lifestyle can help with the symptoms of the male menopause
So while a significant number of middle-aged men may have low testosterone, hormone specialists insist that only a fraction, perhaps two in 100, need treatment, and that’s because they have a genuine disorder, hypogonadism (where the testicles don’t produce testosterone as a result of disease or damage).
The idea that only these men need extra testosterone has been endorsed by the U.S. Food and Drug Administration (FDA), which this month announced that testosterone products must now carry a warning about the ‘possible increased risk for heart attacks and stroke’.
Manufacturers must also spell out that the medication is approved ‘only for men who have low testosterone levels due to disorders of the testicles, pituitary gland or brain that cause hypogonadism’.
The FDA said it was aware that testosterone is used by some ‘for no apparent reason other than ageing, and the safety of this use has not been established’.
But not everyone shares these worries. Official European guidelines, issued four months ago, insist there’s ‘no consistent evidence of an increased risk of heart problems with testosterone medication’.
And British doctors who use testosterone for patients with sexual problems — notably low libido and erectile dysfunction — believe male HRT can play a major role in the well-being of many older men.
‘Testosterone replacement therapy is both safe and effective in treating symptoms such as erectile dysfunction in men with low testosterone,’ says Dr Geoffrey Hackett, sexual health specialist at Good Hope Hospital in Birmingham and a former chair of the British Society for Sexual Medicine.
He believes the term ‘male menopause’ is ‘not quite accurate’, adding: ‘After all, only 20 per cent of men experience low levels of the hormone, whereas 100 per cent of women go through the menopause.’
Research shows that severe sleep deprivation can cause testosterone levels to drop by 70 per cent so the more sleep the better
But he says that low testosterone is a real issue for many men, adding: ‘I’d like to see screening for testosterone in all men over 50.
‘Above all, what is important is for doctors to recognise that testosterone treatment should be considered for anyone with low levels who also has sexual dysfunction symptoms.’
And if you’re one of the one in ten men over 50 in England who has type 2 diabetes (in Scotland it’s one in three), he says you, too, could benefit from testosterone treatment.
‘Nearly half of men with type 2 diabetes have low testosterone, and many suffer sexual dysfunction,’ says Dr Hackett. ‘Low testosterone is not the only reason for this — they will probably also suffer from circulation problems, for instance.
‘But we know testosterone helps. And as there’s no real evidence that it’s not safe, why not give these men treatment that will improve their lives?’
The debate over the male menopause and testosterone may be resolved by a major Australian study due to be published in 2019.
It is tracking 1,500 men, aged 50 and over, who are obese and at risk of developing diabetes: all are being given access to a WeightWatchers programme, while half will also receive a regular dose of testosterone. One aim of the study is to see if taking testosterone helps men lose weight. Another is to find out whether HRT for men is safe. So far there has been no reason for concern.
HOW CHANGING YOUR LIFESTYLE CAN HELP
For most men, the best treatment for low testosterone levels is switching to a healthy lifestyle, says Professor Fred Wu, a consultant endocrinologist at Central Manchester University Hospitals.
‘We get a lot of referrals from men who wrongly believe their mid-life symptoms are solely due to age-related low testosterone. This age-related decline in testosterone starts at about 35 or 40, but it’s very slow. It’s very much influenced by health and body weight.’
LOSE WEIGHT: This is the single most effective lifestyle change for boosting testosterone levels. Shedding 10 per cent of your weight — shown to be achievable with regular exercise, a healthy diet and cutting down on alcohol — raises testosterone levels by around 4 nmol/l, according to the European Male Ageing Study in 2013.
‘So, if you have moderately low testosterone, lifestyle change alone can make your levels normal,’ says Dr Mathis Grossmann, a consultant endocrinologist and head of men’s health at Austin Hospital in Melbourne, Australia. The more weight you lose, the better your hormone recovery, he adds.
‘The impact is greatest the younger and fatter you are. But older men can benefit, too. Once weight loss has started, there’s an immediate rise in testosterone that triggers further weight loss, which then raises hormone levels still further.’
U.S. research has recently shown how testosterone instructs stem cells, which have the ability to turn into any cell, to become muscle.
‘Having more muscle creates a leaner physique and greater strength, as well as boosting energy and making the body burn calories more efficiently,’ says Dr Grossmann.
TAKE EXERCISE: You don’t need to be a hardcore gym-goer. ‘A brisk walk every other day is all that’s needed,’ says Dr Quinton.
KEEP TYPE 2 DIABETES UNDER CONTROL: Men with type 2 diabetes are twice as likely to suffer from low testosterone.
It’s not clear which comes first, the low testosterone or the diabetes. But some research suggests low testosterone can reduce the effectiveness of insulin, the hormone that regulates blood glucose levels.
A small number of doctors believe that testosterone should be considered as a treatment for type 2 diabetes in older men.
However a major study, published last year in the journal Diabetes Care, found that this treatment didn’t improve the body’s inability to turn sugar into fuel — a key cause of diabetes.
Men with type 2 diabetes are twice as likely to suffer from low testosterone and some research suggests it can reduce the effectiveness of insulin, the hormone that regulates blood glucose levels
GET PLENTY OF SLEEP: The more you sleep, the more testosterone your body produces. Research shows that severe sleep deprivation can cause testosterone levels to drop by 70 per cent. Indeed, men who get only four hours sleep a night have 60 per cent less testosterone in their blood compared to when they get eight hours.
CHECK FOR DRUG SIDE-EFFECTS: Testosterone levels can be affected by a range of drugs, including beta blockers, opioid analgesics such as morphine, steroids such as prednisolone (used for skin diseases and osteoarthritis) and some epilepsy drugs.
‘If you’re experiencing issues with libido and erections since starting any of these medications, your doctor may help you find an alternative,’ says Dr Quinton.
‘Sometimes there is none. In that case, it makes sense to have testosterone replacement.’
WHAT ABOUT MALE HRT?
Some experts — and men — swear by male HRT. But you’re unlikely to get it on the NHS unless you have hypogonadism.
A handful of private clinics will prescribe it on the basis of a single blood test if these show low levels of the hormone. But under guidelines from the British Society for Sexual Medicine, your levels should actually be tested several times over six months before you get testosterone treatment.
‘While problems of sexual function are common in men, persistent problems lasting for longer than six months are much rarer,’ according to these guidelines.
Men with sexual problems and a testosterone level lower than 12 nmol/l should be considered for treatment, along with men with diabetes, osteoporosis, a history of heart disease or stroke, erectile dysfunction or depression whose levels are low. Men with a reading below 8 nmol/l should definitely be treated.
Testosterone supplements should never be taken by men with prostate cancer, heart failure or heart disease, because it can make them worse. And one study suggested that older men who start taking testosterone in their late 60s may have a raised risk of a heart attack or stroke.
Testosterone supplements also act as a contraceptive, so they should not be taken by men wanting to start a family. There are several ways of taking testosterone, including pills, patches and implants placed under the skin during an outpatient procedure.
However, the newer gels and intramuscular injections are ‘far superior’, according to Dr Quinton. The gels are rubbed on daily into the shoulders, underarms and thighs where they are most easily absorbed into the bloodstream.
The injections are delivered every three months or so, either into the thigh muscles or the muscle in the bottom; the hormone is then slowly released by the muscle into the body.
Gels have the advantage of providing a daily dose of testosterone in the same way as the body produces it naturally. But they’re absorbed into the bloodstream quite slowly so you shouldn’t shower or swim for six hours after application.
Injections mean you avoid the hassle of remembering to apply the gel every day. The downside is that levels of testosterone can tail off towards the end of the three-month period.
Read more: http://www.dailymail.co.uk/health/article-3003472/Grumpy-lethargic-low-libido-man-hit-male-menopause.html#ixzz3Uvcy4aVb
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