Oct. 16, 2000 -- Testosterone has been the subject of controversy recently,
fueled partly by an April cover story in The New York Times Magazine.
Author Andrew Sullivan extolled the effects of the hormone as treatment for his
HIV-induced deficiency. Citing bursts in libido, confidence, and energy as a
result, he refers to his testosterone injections as "a biweekly encounter
with a syringe full of manhood."
Interest rose even higher when, shortly after Sullivan's piece appeared,
AndroGel was introduced on the market. The injections used in Sullivan's
treatment are painful (he describes the three-inch needle and the resulting
trickle of blood) and produce wildly erratic hormone levels (huge burst shortly
after the injections, insufficient levels a few days later). But AndroGel, a
user-friendly cream containing androgens (the class of steroid hormones to
which testosterone belongs), can be absorbed through the skin. AndroGel boasts
no-muss, no-fuss easy daily applications that produce far more consistent blood
levels of the drug. A cover story in Time Magazine on this development
aroused further lively media coverage.
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All this buzz about testosterone supplementation evoked a burning question,
especially among men of a certain age: Where can guys who are no longer
teenagers sign up for this stuff?
The Story Behind the Story
Unfortunately, the optimistic reports about testosterone have omitted some
important information, such as the need for painful injections. And they failed
to consider the very basic question: Do most men need extra testosterone to
reverse some of the typical declines in sexuality as they age?
Interestingly, the answer is no.
Extra testosterone can definitely improve the lives of men with extremely
low levels of testosterone due to disease -- say, 5% of normal, due to
conditions such as the removal of a pituitary tumor, removal of the testes (in
the case of testicular cancer, for example), or in Sullivan's case, HIV. In
these cases, the lowered level would likely affect libido. If you were to boost
such a man's testosterone levels by giving him supplemental doses of the
hormone, you would expect his behavior to return to normal. That was Sullivan's
experience, with some healthy placebo effects tossed in on top -- a possibility
he barely raises in his piece.
But most men simply don't need AndroGel. Here's why.
Testosterone and the Aging Male
Testosterone levels tend to decline gradually in men, starting in early
middle age. The popular perception, and one trumpeted throughout Sullivan's
piece, is that this decline is a cause of the typical decrease in energy, edge,
and sex drive that often accompanies aging.
But there is simply no scientific data to support a cause-and-effect
relationship between the (slow) decline in testosterone experienced during
normal aging and a negative impact on libido, sexual performance, or level of
energy. Furthermore, even the temporary declines in testosterone experienced by
many men during periods of stress (traffic jams, a poor evaluation by a
superior) typically do not appear to make any long-term difference in their
libido and performance, either.