Hormones 2016

The real side effects of testosterone replacement therapy for men
What happens during male menopause?
Menopause in men is difficult to diagnose, given that it happens gradually
over decades, and lacks the defining moment that women experience when
their periods stop. A man’s testosterone levels reduce by around 1% per
year from the age of thirty, and research shows (Feldman, 2014) that by the
age of 60, a man has on average around 20% less testosterone than he had
at puberty, and by the age of 80, around 50% less.
The symptoms commonly associated with male menopause include a loss
of lean muscle mass and tendency to put on weight, low libido, difficulty
maintaining an erection, depression, loss of vitality and physical strength,
sleep disturbances, reduced cognitive function, and hot flushes. The main
reason these symptoms occur is due to a reduction of free testosterone in a
mans body, the active form of male sex hormone. Alongside this, an increase
in sex hormone binding globulin is seen, which binds to testosterone and
prevents it being usable by the body. We may also see a change in the
testosterone to oestrogen balance around this time, due to an increase in
the enzyme aromatase, which converts more testosterone to oestrogen. This
enzyme is found in your fat cells, as well as your adrenal glands, which is
why those medically classed as obese are more likely to experience these
symptoms.
What is testosterone replacement therapy?
Testosterone replacement therapy is designed to raise testosterone levels,
to help prevent symptoms associated with its deficiency. It is available in
a variety of formats, including gels which are rubbed onto the skin, oral
tablets, injections, and patches. A number of studies have been done to
assess which is most effective, however it has not yet been proven which
type of preparation raises testosterone levels most efficiently.
The benefits found in research (Huanguang et al., 2015) from taking testosterone
replacement therapy include a minor to moderate improvement in
lean body mass and muscle strength, increased bone mineral density, a
modest enhancement in sexual function, a reduction in body fat, and a
reduction in depressive symptoms.
Who requires testosterone replacement therapy?
It is difficult to assess which men should be given testosterone replacement
therapy, because there are a lack of established reference ranges for ’normal’
testosterone. Testosterone levels vary greatly between individuals, and if a
man has always had fairly high testosterone levels and these drop to normal
ranges, he may experience the same symptoms as a man whose levels have
dropped from normal to low. Generally, the prescription of testosterone is
assessed based on hormone levels, as well as symptom analysis.
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