Menopause Not Just For Women
A Questionable Past
The first successful use of hormone replacement was carried out
150 years ago by a German professor named Berthold who transplanted a rooster's
testes into another castrated rooster. This procedure prevented the castrated
rooster's comb from withering away. That study was followed by numerous other
experiments using testicular transplants and extracts.
Testosterone was only isolated and synthesized 60 years ago.
However, the oral form can be toxic to the liver and heart, and that,
Carruthers says, has "colored the thinking of two generations of
Another problem associated with the diagnosis of "male
menopause" is that only about 13% of men with symptoms have a low total
testosterone level. Carruthers and others, however, say doctors need to
evaluate the level of free active testosterone, or FAT, rather than total
testosterone levels. FAT is obtained by dividing the total plasma testosterone
level by that of the sex hormone binding globulin, or SHBG. This turns out to
be low in 74% of the men with menopausal symptoms. SHBG increases with age and
"zaps" the free testosterone before it can get into the cells to do its
Still, Skeptics Abound
Skeptics of andropause still abound. In an article in
American Journal of Psychiatry, UCLA psychiatrist H. Sternbach concluded
that "testosterone decline/deficiency is not a state strictly analogous to
female menopause and may exhibit considerable overlap with primary and other
secondary psychiatric disorders."
British urologists N. Burns-Cox and C. Gingell concluded in
another medical journal that "the symptoms of the andropause fatigue can
readily be explained by stress, and there is no scientifically valid ... study
that shows any benefit for testosterone supplements in this uncommon group of
Carruthers, however, has been following men who have taken
testosterone supplements for up to five years, and he has concluded that the
supplements cause no negative effects on their hearts, livers, or
And Dott and Karpas point out that when it comes to diagnosis,
doctors should not just evaluate testosterone levels. "Good medical care
dictates that a comprehensive medical and psychological assessment along with a
thorough laboratory assessment are necessary," they say.
Possibly this debate will be solved once Bain completes his
analysis of data comparing men with "menopausal" symptoms on hormone
replacement with men receiving placebos. If so, will men rush out to get
hormone replacement therapy? Stay tuned!