An upsurge in media attention recently regarding the so-called "male menopause" has left many men rushing to their doctor to treat symptoms they believe may be related tolow levels of testosterone. The concept behind the concept of male menopause is that the decline in testosterone levels that occurs as men age may produce a characteristic and potentially treatable set of symptoms. Male menopause is also commonly referred to as low-T, andropause, or its medical name, late-onset hypogonadism.
However, some medical experts argue that the analogy to the process in women (with some authors even using terminology like "male PMS") has been carried too far. While it is true that testosterone levels do decline as a man ages, the decline in female hormones occurs to a much greater extent. Moreover, the symptoms in women associated with decreased estrogen levels are clearly understood.
In contrast, symptoms of what is referred to as male menopause are less clearly defined. Sexual dysfunction is a common complaint, but other nonspecific symptoms such as depression, mood changes, weight gain, or fatigue, have been interpreted by some as symptoms of a male midlife change. Although many doctors have treated midlife symptoms in men with testosterone hormone therapy, the value of male hormone therapy remains controversial because there are few long-term studies about the effects or benefits of testosterone supplementation.
Still, prescriptions for testosterone are on the rise, even if doctors don't yet agree on whether or not this therapy should be recommended.
In 2006, the Endocrine Society published evidence-based guidelines for testosterone replacement therapy in men. Specifically, for men who do not have testicular or pituitary disease, these experts recommend testosterone therapy only for men with definite and reproducibly low serum testosterone concentrations (<200 ng/dL) who have symptoms of androgen deficiency (symptoms of deficient blood levels of testosterone hormone).
As with any therapy, doctors will discuss the uncertainty about the risks and benefits of testosterone therapy. Experts further recommend that the therapeutic goal in these men is to reach a testosterone level that is lower than that for younger men, for example, 300 to 400 ng/dL, rather than 500 to 600 ng/dL, to minimize the potential risk of developing any testosterone-dependent diseases.
REFERENCE: Bhasin, S, Cunningham, GR, Hayes, FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2006; 91:1995.
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