Men : What Happens After 50?

After men reach fifty years of age, Testosterone levels decline gradually culminating in low levels called the male Andropause. At age 70, Testosterone levels may have declined by 30 to 50 percent.

Symptoms of Low Testosterone

Low testosterone symptoms include muscle weakness, reduced libido, depression and loss of mental acuity. Symptoms are reversible with testosterone therapy.

Testosterone Therapy Is Increasing

About 2 million prescriptions for testosterone were written in 2002, representing a 30% increase from 2001, and a 170% increase from 1999. Testosterone prescriptions have increased 5 fold over the past 10 years, in part due to increasing recognition of the low testosterone condition in aging males.

Adverse Health Effects of Low Testosterone

Medical studies suggest an association of low testosterone with increased morbidity and mortality. For example, there is a higher prevalence of depression, coronary heart disease, osteoporosis, fracture rates, frailty and even dementia with low testosterone levels.

Low Testosterone Predicts Increased Mortality

Dr Khaw reported in Circulation 2007 that “In men, endogenous testosterone concentrations are inversely related to mortality due to cardiovascular disease and all causes.” Dr Gail A. Laughlin reports in 2008, that “Testosterone insufficiency in older men is associated with increased risk of death over the following 20 years”.

Resistance to Use of Testosterone by Mainstream Medicine

Some doctors are resistant to the use of testosterone in males with low testosterone levels.  One of the reasons for this resistance to testosterone therapy is the history of  synthetic testosterone use in the 1940s and 1950s, with methyltestosterone,  a chemically altered version of testosterone not found in nature, and  later found to cause cancer and heart disease.  Following these revelations, testosterone use declined.

BioIdentical Testosterone

Interest in testosterone use was renewed in the 1980s with availability of the human bio-identical testosterone as topical creams, gels and injections.  This is the exact same testosterone molecule that exists in the human body naturally.

Reputation from Sports Abuse

Testosterone has a terrible reputation stemming from a history of abuse in professional sports. After all, it is an anabolic steroid, and overachieving athletes have been found to cheat by using illegal anabolic steroids to gain competitive advantage.   Young males may also be tempted to follow their example.  One study from the University of Minnesota estimated that 5.9 percent of male high school seniors have taken anabolic steroids.

Controlled Substance

In response to problems with athletes and sports abuse, Congress ruled Testosterone a Controlled Substance in the same category with addictive drugs such as morphine and oxycontin.  Penalties for illegal use are severe, with 5 years imprisonment for any doctor who prescribes testosterone improperly. No wonder doctors are reluctant to prescribe it.

Institutional Medicine is Opposed to the Idea

On November 12, 2002, an Institute of Medicine panel (IOM) convened in Washington DC and declared that, “Existing scientific evidence does not justify claims that testosterone treatments can relieve or prevent certain age-related problems in men.” I would disagree with this IOM statement.  There are literally dozens of studies in the medical literature showing health benefits and safety of testosterone therapy. I believe that a normal level of testosterone, sustained for a lifetime, is one of the most important ways for men to maintain good health.

Benefits of Testosterone

Benefits include positive effects on mood, energy levels, verbal fluency, strength, increased muscle size, decreased body fat and increased bone density. There is also an anti-depressant effect.

Testosterone Benefits for Metabolic Syndrome and Diabetes

Low Testosterone has been linked to metabolic syndrome and diabetes, and testosterone treatment has been found beneficial.(19-20)  In a 2011 study by Marsh and Jones from Sheffield England, testosterone treatment reduced the six year mortality in a Diabetic population by over fifty per cent. This is an excellent reduction in mortality with a single intervention (Testosterone).

Benefits of Testosterone: Heart and Circulation

Dr. S. Dobrzycki studied men with known coronary artery disease and showed they had significantly lower levels of testosterone (J Med Invest 2003). He also showed that lower testosterone levels was associated with reduced pumping ability of the heart.

Dr. C.J.  Malkin showed that testosterone therapy reduced the risk of death from abnormal heart rhythms (arrhythmias).  This was published in the American Journal of Cardiology in 2003. Dr CJ Malkin has published dozens of studies on the beneficial effects of testosterone for cardiovascular health.  For example, Dr. Malkin reports that Testosterone acts a protective factor against atherosclerosis and plaque formation in our vascular tree.    (J Endocrin Sept 2003).

Dr. Gerald Philips at Columbia University, and  Dr. Joyce Tenover of the University of Washington have published many studies over the years on Testosterone therapy, showing that low testosterone is a health risk, and testosterone treatment beneficial for health. Dr. Eugene Shippen presented at a meeting I attended, in which testosterone therapy was used to successfully reverse diabetic gangrene of the lower legs and avoid amputation in many cases.

Testosterone Improves Cognitive Abilities:

Dr. Cherrier has an impressive array of studies which show testosterone improves cognitive and verbal abilities in men.

Safety Regarding The Prostate

Does Testosterone Therapy cause Prostate Cancer?  The answer is NO and is clearly found in the medical literature.  Dr. Rhoden, in the January 2004 issue of the New England Journal of Medicine, reviewed 72 medical studies and found no evidence that testosterone therapy causes prostate cancer. In fact, they note that prostate cancer becomes more prevalent exactly at the time of a man’s life when testosterone levels decline.

Does Testosterone Cause Prostate Trouble?

Dr. Perchersky published a study in the International Journal of Andrology (2002), which examined men with low testosterone levels. He looked at multiple parameters, including prostate volume, PSA, and lower urinary tract symptoms like frequency and urgency. Of the 207 men studied, 187 responded favorably to testosterone treatment. A 2006 study by Leonard Marks, MD in JAMA again shows safety of testosterone therapy.  “No treatment-related change was observed in prostate histology, tissue biomarkers, gene expression, or cancer incidence or severity. Treatment-related changes in prostate volume, serum prostate-specific antigen, voiding symptoms, and urinary flow were slight.”

Adverse Side Effects of Excess Testosterone.

Adverse side effects from excess Testosterone administration listed in the medical literature are: sleep apnea, breast enlargement, testicular atrophy, excess blood count (polycythemia), and acne. Prostate issues such as possible stimulation of benign growth of the prostate (BPH) and worsening of urinary symptoms and stimulation of pre-existing prostate cancer growth are also included in this list. With careful monitoring of clinical and laboratory parameters, and keeping Testosterone levels within the normal range, these side effects can be avoided or minimized.

Monitoring of Testosterone Therapy:

Initially, a careful history and physical examination is required, as well as a testing panel which includes not only free testosterone levels, but also many other important parameters. As usual, it is important to work closely with a knowledgeable physician who is readily accessible and who can monitor adverse side effects and adjust treatment.


Jeffrey Dach MD

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