Men and women often suffer the same ailments but rarely in the same fashion. A good example is menopause, the loss of hormone production that naturally accompanies aging.
In women, the loss – usually beginning around age 50 – is sudden and complete. But the loss of testosterone in men begins earlier and occurs progressively – about 1% per year after age 30 — with less severe symptoms. Men often begin to lose their sexual potency but “brain fog” and other mental and physical deterioration associated with female menopause is absent.
For this reason, the diagnosis of “male menopause” – an artifact of political correctness, perhaps — is not widely accepted by physicians. The fatigue, weakness and even depression that are associated with a loss of testosterone could also be due to diabetes or alcohol abuse, for example. In fact, some men continue to produce sperm well into their 80s; many retain a high degree of potency even as seniors.
Calling men “menopausal” much less “post-menopausal” seems to stretch a useful label a bit too far.
Indeed, concern over the loss of testosterone may be as much cultural, as physical. Men are eager to retain their youthful image and vigor, including their ability to perform sexually. If there’s a quick fix for their condition, they want it. That may be pushing them to embrace a variety of testosterone replacement therapies (TRT) which promise real benefits — but also carry significant risks.
Research shows that TRT can increase male libido and energy levels while increasing bone density and muscle mass. Moreover, the anecdotal evidence of success – just surf the Internet for testimonials – is overwhelming. However, the risks are clear, too. TRT can induce sleep apnea, increase the risk of heart attack and stroke and stimulate blood clots in the veins, among other side effects. In addition, long-term use of herbal supplements such as DHEA – often billed as a “safe and natural alternative to TRT — can contribute to prostate cancer.
Despite these risks, the consumer demand for TRT is growing rapidly, reaching $1 billion in 2010. Many men begin receiving treatment in community-based clinics and alternative clinics that are critical of the medical establishment’s approach to “low T.” Increasingly, they are approaching their primary care providers (PCP) with questions about TRT, often in response to expanded late-night TV and online advertising for TR products, including supplements.
Interestingly, the FDA has tried to steer clear of the current controversy, initially refusing to endorse the most adverse risk predictions but still advising care providers to weigh benefits and risks more carefully. However, in 2018 the FDA adjusted its safety advisory to include the risk of heart attack and stroke. It also called upon the leading TRT manufacturers to being organizing clinical trials to gather more convincing research evidence on the efficacy of their products
Currently, most TRT therapies, especially transdermal gels, which are considered the most effective, are fairly expensive. These gels (including common brands like Androgel and Testim) which are easy to apply are especially popular among those that can afford them. Other delivery systems include injections, mouth or skin patches, implanted pellets and finally, oral tablets are considerably less expensive.
Each system has its functional advantages and disadvantages. Gels must be applied by hand to the chest or abdomen and can transfer testosterone to those you come in contact with. However, but unlike injections, gels do not require regular office visits. Patches require once-daily administration; nasal sprays must be used three times daily. Most doctors believe that oral administration is the worst and most unreliable means because the liver breaks down the testosterone and renders it ineffective.
Currently, about a third of the current TRT treatments are a result of prescriptions from family-based providers. Most but not all insurance plans do cover TRT as a Tier 2 drug, but with high co-pays in most cases.
For many, “low T” is a bit of a luxury problem. Not all men recognize the condition let alone seek treatment for it. Shame and embarrassment over their loss of sexual potency may be one factor. A continuing lack of consistent and reliable medical information on TRT is another.
Moreover, men, unlike women, may be less likely to inquire about any form of sexual dysfunction, especially when the condition and its symptoms seem less physically and psychologically debilitating overall.
Still, in today’s world, with rising demands for a longer healthier life, interest in TRT is bound to grow. By whatever name — “andropause” or “testosterone deficiency syndrome” are commonly used terms for male menopause – hormone loss is a reality for men. With more research and safer less expensive treatments, TRT may one day be as common a remedy as laser surgery.