Cover Story

As the confusion over hormone-replacement therapy for women continues, another controversy is waging over whether men should take hormones for their own form of menopause, known as andropause.

The condition is largely caused by testosterone deficiency. At age 40, men's testosterone levels in the bloodstream generally decline by about 1 percent each year. Symptoms include decreased libido, lack of energy, height loss, irritability, sadness and decreased strength.

But aren't many of those "symptoms" just a normal part of middle age? No, say many of the nation's doctors and Unimed, the makers of Androgel, a clear gel packed with testosterone that's rubbed onto areas of the body--normally the shoulders--once a day. The company's advertisements claim that four or five million men are "andropausal."

Androgel was approved by the Food and Drug Administration (FDA) in 2000 for the treatment of pituitary dysfunction and Klinefelter's Syndrome, a congenital disorder in which men have an extra X chromosome and under-developed testes. Because it has been dubbed safe by the FDA for those conditions, physicians can prescribe it for any clinical condition the drug might benefit.

This summer, a panel of experts released recommendations at the annual meeting of the Endocrine Society that suggested that men whose morning testosterone levels were under the normal limit of 300 would probably benefit from treatment. More than half of the panel's 13 members had financial ties to Unimed. Also notable, men's testosterone levels seem to vary naturally at different times.

Some studies have suggested that giving testosterone to healthy aging men can increase muscle mass and strength, though other studies have not been able to prove those benefits or others, such as increased energy or sexual performance.

Skeptics believe male menopause is just one of many examples of the medicalization of aging. Ronald F. Levant, EdD, an expert on the psychology of men and dean and professor of psychology at Nova Southeastern University, says the cart may be coming before the horse on the issue of male menopause.

"I'd call it the andropause hypothesis rather than the andropause phenomenon," he says. "It's just not on the same par as menopause. The effects of andro-pause have barely been studied."

In fact, the National Institutes of Health concluded last year that andropause has not been scientifically validated.

He adds: "Aging is something our society doesn't deal well with. Men, in particular men who were reared to assume the traditional role of men, find it hard to admit vulnerability. Part of aging brings on vulnerability."

And ironically, he says, these "men who believe that men are invulnerable are particularly vulnerable to the myth that if they take medications it will solve their problems"--even those problems that may be just a part of the aging process.

--J. DAW