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Testosterone: Shot in the Arm for What Ails Aging Males

The therapy helps men struggling with low levels of this key hormone

MONDAY, Aug. 5, 2002 (HealthDayNews) -- You're a middle-age guy who can still spot your 40th birthday in the rear-view mirror without having to squint through your new glasses.

However, you can't quite shake the nagging suspicion that your performance is starting to slip -- in the boardroom, the bedroom, or the sports field.

The problem may be low testosterone levels. And a simple 10-part questionnaire could help determine whether testosterone replacement therapy is the way to put that spring back into your step.

Lack of energy, depression, decreased work and sports performance, falling asleep after dinner, muscle loss, fat gain, low libido, weak erections -- these are just some of the symptoms of low testosterone levels, also referred to as andropause.

It's a common problem. The U.S. Food and Drug Administration estimates that 4 million to 5 million American men suffer from low testosterone, but only about 5 percent receive treatment.

The Androgen Deficiency in Aging Men (ADAM) questionnaire could improve those treatment numbers by helping men 40 and older recognize the signs of testosterone decline, a slow process that can occur over 10 to 15 years.

The questionnaire was developed by gerontology professor Dr. John Morley, director of the geriatric medicine division at St. Louis University School of Medicine.

"We used to say, 'You're getting old.' Well, now we know you're getting old because your male hormones are going down, and replacement of your male hormones may make you feel younger and be more active and more effective," Morley says.

It would be far too expensive to do regular hormone tests on all men over 40. So, the questionnaire is a cheap, effective screening tool to educate and encourage men to talk with their doctors about low testosterone.

If a man's answers to the 10 questions show a potential problem, his doctor can then do a hormone test to check the testosterone levels.

If there's a deficiency, the man may need testosterone replacement therapy, which can offer a major improvement in the quality of his life, Morley says.

At least 70 percent of men who have testosterone replacement therapy get relief from their symptoms, and almost every man will have an increase in his muscle mass and perhaps in his bone mineral density, Morley says.

"It's very effective. You can normalize testosterone levels," says Dr. Richard F. Spark, director of Beth Israel Deaconess Medical Center's Steroid Research Lab in Boston.

Some compare low testosterone in men to menopause in women, but Spark says that's somewhat misleading.

"There is nothing dramatic that happens in men, like the hot flashes occurring in women that signal that there's some disruption in hormone production," says Sparks, who's also the author of Sexual Health for Men: The Complete Guide.

While women experience an abrupt decline in estrogen production, men have a gradual ebbing of testosterone.

Many men on testosterone treatment feel stronger, more confident, have an improved sense of well-being and are more effective at work, Spark says.

In the United States, testosterone replacement therapy is done three ways -- with injections, skin patches or skin gel. Injections are administered every two weeks; the patches and gel need to be applied every day.

It's also a lifetime commitment.

"If they want to keep their testosterone levels increased, they will have to do this for the rest of their lives," Spark says.

He cautions that testosterone therapy isn't a fountain of youth. If you're 60 years old, it won't restore your buff 21-year-old physique -- if you ever really had one.

"There are other men who are expecting too much from the treatment, and are disappointed when they don't get the results that they fantasize about," Spark says.

As for side effects, "the major concern has always been whether testosterone supplementation would put a man at greater risk for developing prostate cancer than men who haven't received testosterone supplementation," Spark says.

"But there's really no evidence that testosterone supplementation puts a man at greater risk for developing prostate cancer than another man his age who has the same testosterone level normally and is not taking testosterone supplements," Spark adds.

Some men receiving testosterone treatment also need to have their red blood cell count monitored. The therapy can sometimes elevate red blood cell counts to dangerously high levels, and could increase the risk of stroke. In those cases, the testosterone treatment should be stopped, Spark says.

Here's the ADAM questionnaire. If you answer "yes" to questions one through seven, or "yes" to three or more questions, Morley suggests you make an appointment with your doctor to discuss the results.

  • Do you have a decrease in libido?
  • Do you have a lack of energy?
  • Do you have a decrease in strength and/or endurance?
  • Have you lost height?
  • Have you noticed a decreased "enjoyment of life?"
  • Are you sad and/or grumpy?
  • Are your erections less strong?
  • Have you noticed a recent deterioration in your ability to play sports?
  • Are you falling asleep after dinner?
  • Has there been a recent deterioration in your work performance?

What To Do

For more information, here's a site that explains andropause. You can learn more about hormones at Dr. Spark's Web site.

SOURCES: John Morley, M.D., B.Ch., gerontology professor and director, geriatric medicine division, St. Louis University School of Medicine; Richard F. Spark, M.D., associate clinical professor, medicine, Harvard Medical School, and director, Steroid Research Lab, Beth Israel Deaconess Medical Center, Boston
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