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Male menopause: High hopes for Low-T do not match results

Posted on May 5, 2012 By Curt Werner Health

The television commercials for low testosterone levels, “Low-T” in shorthand, can be as common as Romney ads in Republican primary states.

Rotated more conspicuously during major sporting events like the World Series and the Super Bowl, the Low-T ads portray a harried, somewhat depressed male of uncertain middle age as bent, if not broken, by a range of woes both deeply personal and outwardly professional. These days that guy in the ad, dressed in a nondescript dark gray shirt and drab green pants that vaguely resemble the wardrobe of the average Chinese worker in the days of Mao, is something of an Everyman, struggling mightily against economic and social forces that are somehow beyond his control. It’s no wonder money and job problems might spill over into marital strife. The economy might be improving, but life can still be tough.

Male menopause and Low T

Low T: Low testosterone levels, known medically as hypogonadism, can be devastating to men and are often a precursor to serious conditions like obesity, diabetes, sexual dysfunction, high blood pressure and asthma/chronic obstructive pulmonary disease or COPD. (Shutterstock photo)

Cheer up, says the sympathetic voiceover, we have just the thing: A pill! How utterly American. How appealing!

But are the poor guy’s gloomy attitude, distressing body language and zapped energy, the result of a layoff, an out-of-control kid, an out-of-control life, or all three? Is it a consequence of “male menopause” or simply an aspect of normal aging? Or, is it some sort of correctable hormonal imbalance? Could this all just be part of an anti-aging craze in this country?

Make no mistake, low testosterone levels, known medically as hypogonadism, can be devastating to men and are often a precursor to serious conditions like obesity, diabetes, sexual dysfunction, high blood pressure and asthma/chronic obstructive pulmonary disease or COPD. As such, hypogonadism almost always requires treatment, sometimes with hormone replacement therapy or with medications through patches, gels or injections, depending upon your concern about fertility.

Against myth, hormone imbalances are not exclusively female. Men, in fact, do experience many of the same conditions as women when it comes to low hormone levels.

There is medical evidence that confirms the existence of “male menopause,” although no true consensus has been reached and the expression itself is generally not considered a medical term (Oh those Mad Men!).

  • Actual Low-T cases extremely rare

But back to the diagnosis and the pill. Who doesn’t want – or need – a pick-me-up? Therein lays the undeniable appeal of Low-T products in pill form (although you might say the same about energy drinks). The problem is that according to a 2010 study published in the New England Journal of Medicine only 2 percent of men age 40-79 actually suffer from late-onset hypogonadism, making it highly unlikely you are among the one in 50 who could enjoy quick relief.

Not unlike the Republican TV ads, the notion of Low-T appears to be just a case of smart and frequent advertising that turns heads and creates a need. After all, at least partially in response to the ads, millions of prescriptions are written to aid a condition that rarely exists.

By one estimate, hormone therapy, an area rife with charlatans, has increased an astonishing 400 percent in the U.S. since 1999, although such enormous numbers have not been observed in other countries where those snappy ads are not seen.

As in all things purchased, buyers beware. Just take a nap, read a good book or work out. You’re probably just fine.

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Medicine, Men's health

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  • Marilyn

    This is the first time I had the opportunity to read some of your work.  I really enjoyed it!!  Post more!

    • Curt Werner

      A belated thanks, Marilyn.

  • Joan

    Thanks for posting, Curt. Very interesting information and well written!

    • Curt Werner

      Thank you, Joan.

  • Jehendricksmd

    The reporter who wrote this is absolutely wrong here, men.  As a physician, my experience with testing for testosterone has shocked me.  I am speaking from experience and I can say that by the time I started to test for hormone levels in men, 80% of them had laboratory verified low testosterone.   Especially when I looked at free testosterone in addition to total testosterone.  This is an admission on my part of failing my patients.   Even more shocking was when I began testing men younger and younger even into their early thirties and in some cases twenties, looking for where this trend is starts, I am seeing thatt as many as 60% of men I am testing in their thirties have low testosterone.  Men today have almost 25% less testosterone than their fathers.  A decline that rapid can only mean there is a large environmental factor at work, as a genetic change that significant would take decades if not hundreds of years to manifest.  I don’t have time in this response to get into the why of that but saying that only 2 percent of those 40-79 are affected is misleading if not totally inaccurate.  Its like saying we have only 2 percent of the population with severe morbid obesity.  That falsely implies that the other 98% of the population is of normal weight when we clearly can see many people are still obese or  at least overweight.  I have treated probably more men for low testosterone than anyone in my area and do you know why?  Because most of my colleagues aren’t routinely testing for this common occurrence and they are missing it, just like I used to.  Also, do you know the total amount of money I have made from Testosterone hormone sales?  $0.00.  I have never and will never make a penny from the sale of it.   Nor should I, it would be unethical and a conflict of interest.  Pharmacies make that money, not the doctor.  Contrary to popular belief, no matter what medication I prescribe or don’t prescribe, I will never be the one to profit from it.  That is the way it should be.  I am paid for my time, my medical knowledge and expertise, and my opinion and advice.  With a full practice, there is no incentive for me to state anything other than the truth about what I see.    

    • Curt Werner

      As the author of the article I’d like to respond to your critique and even engage in a friendly debate. First off, nothing in the article suggested or implied that you or any physician for that matters, profits from the prescriptions they write. As you say, that would be a conflict of the first order. Nevertheless, there is a strong profit motive at work here, It’s the drug companies that spend millions of dollars annually on direct-to-consumer advertising, precisely because that form of advertising, which didn’t exist until the mid-1990s, works and works exceedingly well. I have not seen figures, but I am sure that the Low-T ads reap very significant returns. Advertising, particularly television advertising is unquestionably a powerful force. Unfortunately, the same goes for advertising, chiefly on the internet but also on TV and radio, that offers worthless drugs and supplies day and night. I’m sure you agree that advertising does not always work in favor of the public good. Claims are often wildly exaggerated or worse, untrue in some cases.
      On the plus side, the Low-T ads could be credited with starting a dialogue between patient and doctor and that is always a good thing to my way of thinking.
      I am also inclined to believe, like I suspect you do, that clinical studies sometimes depart from a more effective one-on-one dialogue between physician and patient, and that modern medicine can sometimes rely too heavily on some studies, failing to take into account the individuality of patients in a one-size-fits-all mindset that often happens on busy days in the office. This could be the case with the hypogonadism study, although I am not a clinician and have no evidence to the contrary. But it does appear that the scientific evidence is clear that men 40-79 are far less affected by low testosterone than the ads of the Low-T variety make it appear. I would be interested in finding out how your male patients in their 20s and 30s fare. Do you prescribe the drug in question? What do follow-up visits show? Do those younger patients present with fewer issues?
      To me is the crux of an article that both patients and doctors should view DTC ads with a degree of skepticism. That would seem to be the healthiest choice of all.

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