Men, Hormones, and Aging

It’s noon on St. Patrick’s Day, and I am at the Cleveland State University gym.
Noontime ball is in full swing.
And lunchtime lifters are going at it.
A youthful athlete on the chin-up bar struts his stuff for the microphone:

Chiseled abs, grunts of exertion, a body that can bench twice its own weight—a gym is full of those “manly” physical traits that exude...testosterone. And so, I thought, it’s as good a place as any to speak with men about middle-aging, and the effects that changing testosterone levels could be having on their bodies. Are they even aware of it? Do they understand that very low testosterone levels can sometimes be the cause of low libido, or as some researchers call the problem, “Sexual Desire Dysfunction?"’s not a subject that a lot of guys want to talk about…with a stranger, a woman…holding a microphone. But I did met one gym-goer at Cleveland State willing enough to share.

Aaron—who just gave me his first name--is making short work of a punching bag.

AARON: I’m 40, I try to stay active, I jump rope, I hit the bag, I spar, ride my bike to work when its nice like today.

Aaron’s well-built, but even he admits that’s its harder to stay in shape now than when he was in his 20s.

AARON: I just notice that I can’t…I used to be able to play basketball for three hours. Now, maybe an hour and then I’m starting to be like uh I’m kind of achy.

While most of his “middle-aging” friends are active like him, some complain about having less energy and losing muscle mass, as they get older.

Put another way - guys start to lose some of their “edge,” and the loss involves more than muscles. What we know is this: as men age, their testosterone levels gradually decline, on the order of 1-1.5% a year. Unlike menopause—which involves a more sudden drop in estrogen levels for women—testosterone falls slowly and progressively, starting in the late 30s. This decline of the predominant male hormone can be associated with several symptoms:

SABANEGH: There are classic symptoms that we’ve known about for many years: decrease in sexual desire or libido, decrease in erectile function, but now we’re realizing that its much more involved than that.

Dr. Edmund Sabanegh, Cleveland Clinic’s Director of Urology

SABANEGH: We can see a decrease in our energy level. We can see a decrease in our ability to concentrate, our cognition. We can see irritability. We can see a change in our body fat, our muscle mass. We can see actual physical changes in our bodies.

There can be many causes of these feelings and these physical changes. Lower testosterone can be one contributor ….and some men see a simple solution. Jack up their testosterone level. It’s easy to do now with a gel, a patch, a shot.

AARON: Um yeah I’ve heard someone say that before.

Aaron, from the CSU gym, tells me more about his friend, who is in his 50s:

AARON: I mean he just says he wants to go to the doctor and get a testosterone shot. He just says he’s losing his drive and everything like that. He’s like, I want the T! That’s what he calls it.

Aaron’s friend isn’t alone in wanting “the T. “ Between 2002 and 2008, the number of prescriptions for testosterone gel increased by 97 and a half percent, according to FDA figures. Word of mouth and TV ads, such as those during the NBA playoffs, have driven sales up.

One person with a script is Tom Chiarella, a writer at large for the men’s magazine Esquire, who may end up writing about his personal experience with the topic. Chiarella, now 50 years old and living in Indiana, says that about five years ago he noticed it was harder to get himself motivated, he started gaining weight, had a lower sex drive, felt more aches and pains, and it was difficult for him to muster the energy to come up with story ideas, and do his job. It was, he says, a crisis of ambition.

After trying depression meds and other treatments, his doctor brought up the possibility of hormone therapy:

CHIARELLA: I didn’t really understand it and I really thought…Testosterone…I didn’t really know what it was for, just thought it was something related to testicles which you know it is, but it’s also related to behaviors. The doctor then repeated back to me the symptoms I had described to him and he said these are all things related to what testosterone does, you know, for men.

So Chiarella starting taking testosterone therapy, and noticed a rapid turnaround:

CHIARELLA: It’s a return, returning my body to a state that, not that’s just comfortable, not where I feel young, but where I know what I am, and the limits of what I am as well.

He now views hormonal therapy with legitimacy:

CHIARELLA: I’ve tried to come to the point where I can understand it with the right supervision, that it isn’t witch-doctory and it isn’t simply avoiding aging. I don’t really want to live forever, I have no interest in that, but I don’t want to live miserably.

Testosterone therapy has undeniably helped Chiarella, and men like him, but experts in the field of men’s health are cautious to prescribe it. Just like with women and hormone replacement therapy, the fit has to be right.

Dr. Peter Snyder is an endocrinologist at the University of Pennsylvania and leads the NIH-funded Testosterone Trial that is following older men using testosterone gel. He says we need to be sure that men taking the hormone actually need it—that they have very low testosterone levels. And right now he thinks some doctors are being too generous with the prescriptions and doling out “the T” because men are looking for a quick fix to feel more vigorous and youthful. Here’s his take home message to a man curious about T:

SYNDER: Don’t take a medicine where there’s not enough information and it’s not clear that the benefit outweighs the risk.

Risks could include increased incidence of heart problems, prostate cancer, sleep apnea, and testicular shrinkage.
Still, some urologists, including the Cleveland Clinic’s Urologist Sabanegh are more optimistic that testosterone therapy can be a great tool when used correctly:

SABANEGH: I think the public is much more aware of this, and we see a growing recognition that this can help.

But he also cautions restraint:

SABANEGH I think that what we do have to be careful of is overuse of testosterone. There may be a tendency to say well I’m feeling a little tired maybe I should try testosterone and that is not a safe or effective for people.

Both Sabanegh and Snyder agree that more research is needed, to definitively determine the benefits and risks posed by testosterone therapy.

Testosterone—our cultural marker of manliness—certainly has a buzz these days, not unlike Viagra when it first came out – the drug that addresses the mechanics of male plumbing, not sexual desire.

But the vast majority of middle-aged men aren’t on any type of T, and probably don’t need to be. The tried and true “therapy” can be found where we started this report…back at the gym.

Doctors say exercise and diet can help most men reduce the symptoms of testosterone they go through the natural process of aging.

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