(Republished with permission from the St. Louis Post-Dispatch. This article originally ran on the front page on Tuesday, August 2, 2005)
By Sam Kean
Grandpa seems shorter than last year. Old men are grumpy. Oh, don’t worry about Earl – he always nods off after lunch.
Sometimes stereotypes are true. Men don’t like to think about it, but they face their own menopause, and shrinkage, crankiness and sleepiness can be the result. Male “andropause” is comparatively gentle: While menopause is a jump-off that can leave a woman in a new body in less than a year, men over 30 lose only 1 percent of their testosterone annually. But the easiness of men’s decline doesn’t mean it isn’t a decline.
The natural medical response is to want to replenish low hormone levels. Yet no large-scale study has done for men what the massive Women’s Health Initiative did for women: Investigate the effects of replacing important sex hormones in the aging. But as demographic shifts bring an increasingly older population, male hormone replacement therapy, or HRT, is becoming a priority.
“We’re trying to slow down the aging process,” said Dr. Ellen Binder of Washington University. “Daily activities, lifting groceries, climbing stairs, walking,” will all improve, she hopes. Other potential benefits include enhanced virility.
This fall, Binder will coordinate a four-month study to give 20 St. Louis men ages 65 to 90 a topical testosterone gel and injections of human growth hormone. Binder plans more studies after this one, and hers is one of three across the country.
Male HRT can encompass a number of hormones, and scientists know the short-term effects of many of them. For example, testosterone, the most important of these, prevents muscle loss and improves spatial-visual skills. That’s one reason baseball players benefit so much from taking testosterone and other substances like it, known as androgens.
But long-term consequences remain obscure. A bit of testosterone may keep a man awake through an after-dinner movie, but it also might increase his risk of prostate cancer. Work such as Binder’s will help decide if and how future studies should proceed. The National Institutes of Health has called such investigations a priority.
Research into male hormones follow the Women’s Health Initiative, a study by the National Institutes of Health that gave 160,000 women estrogen and progestin supplements over more than a dozen years. Its results were mixed. Female HRT delayed or eliminated menopausal discomfort, and women prone to osteoporosis clearly benefited. But the risk of heart disease and breast cancer rose. Statements, based on preliminary data, that HRT would be a panacea for older women were retracted.
But beyond the different hormones involved, male HRT and female HRT differ in a crucial way, said St. Louis University’s Dr. John Morley. For men, researchers will give no more hormones than they would produce normally. As Binder said, the men in her study will not be “superphysiologic.” In contrast, Morley said, women needed doses of estrogen and progestin many times normal to derive any benefit.
Morley, a national geriatrics expert, has helped St. Louis become something of a hub for male HRT. He said testosterone especially holds promise to improve the lives of aging men in modest but real ways.
Testosterone “is very much a quality-of-life drug, much like Viagra,” Morley said. “It makes you feel good.”
And like Viagra, testosterone and other male hormones likely will be quite lucrative. “A billion is a blockbuster, and I’ll be shocked if this isn’t a billion-dollar-a-year industry in a decade,” said Morley. Any “Men’s Health Initiative” is only in the planning stages, but $425 million was spent on testosterone supplements last year. A year’s supply of AndroGel, the most common prescription, runs about $2,500.
Even if male HRT works exactly as it’s supposed to, it doesn’t follow that all men should use it. Endocrinologist Kevin Yarasheski pointed out that hormone levels are supposed to decline. People are meant to get old.
“Some people will say that’s normal, good aging … (Replacing hormones) might promote the growth of things you don’t want like tumors and cancer cells,” said Yarasheski, who will collaborate with Dr. Binder on her study. He added, “and maybe we don’t want to be reproducing when we’re 80.”
Still, Yarasheski said he favored hormone replacement to improve the lives of aging men. As Dr. Morley said, “You can overdo it, both with men and women, but there clearly is a symptom.”
If nothing else, hormone-replacement studies will dissociate the field from its rather unseemly past. Lurid stories abound from the early 1900s: Surgeons at reputable universities grafted goat and primate glands onto unmentionable areas of the male anatomy. Irish poet W.B. Yeats was long rumored to have received a transplant from a monkey.
Such cures have since been denounced as quackery, and it should be noted that Yeats did not in fact receive a transplant. Instead, he left a far more touching monument to old age. The following famous lines are his, lines that speak to the goals of hormone replacement therapy, albeit in a different way:
An aged man is but a paltry thing,
A tattered coat upon a stick, unless
Soul clap its hands and sing, and louder sing
For every tatter in its mortal dress.
A quiz on testosterone deficiency
1. Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased enjoyment of life?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. During sexual intercourse, has it been difficult to maintain your erection to completion of intercourse?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?
Scoring: Yes to No. 1 and No. 7, or any three others, is a positive screen for possible testosterone deficiency.
For more information about the Washington University study for male hormone replacements, call (314) 286-1152.
Source: Dr. John Morley, et al. Metabolism 2000
Copyright 2005 St. Louis Post-Dispatch, Inc.