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The Testosterone Debate: Do Men Really Go Through “Manopause?”

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It’s not only women who experience changes as they get older. Men, too, can suffer from reduced libido, muscle loss, increased weight, and dropping energy levels. Though these are typical symptoms of aging, several testosterone-replacement drug manufacturers used marketing materials and advertisements to link these symptoms to low testosterone levels.

In campaigns termed by some health experts as “selling a disease,” these companies employed media spots and website quizzes to convince men that a low level of testosterone was to blame for their feelings of getting older. Replacing declining testosterone with their drugs, they implied, could help men feel a lot younger again.

The marketing worked. Sales of testosterone replacement therapies doubled between 2006 and 2012, and are expected to triple by 2017. But then in January 2014, the FDA issued a safety communication warning doctors and patients that testosterone drugs could increase risk of heart disease and stroke. In March 2015, they announced that testosterone product labels had been updated to include a warning about a “possible increased risk of heart attacks and strokes in patients taking testosterone.”

Can Testosterone Replacement Therapy Improve So-Called “Male Menopause?”

Do men really go through a type of “male menopause” where testosterone levels fall, similar to a woman’s falling estrogen levels during menopause?

The Mayo Clinic states that though hormonal changes are a natural part of aging, what happens in men and women is significantly different. Whereas women’s estrogen levels plummet during a short period of time, men will more likely experience a gradual decline of testosterone over a period of many years. Because the process is so much slower, it’s unclear if the hormonal changes cause symptoms.

In fact, there are a number of other potential causes of symptoms like fatigue and loss of muscle mass, such as thyroid problems, lack of exercise, or alcohol use. Further, these gradual changes in men are seen as a natural part of aging—not as a medical condition that needs to be treated.

Doctors do connect low testosterone levels with things like reduced sexual desire, erectile dysfunction, and fewer spontaneous erections. They’re referring to truly low levels, however, such as those caused by hypogonadism, a medical issue with the testicles or pituitary gland that results in abnormally low testosterone. This condition is typically diagnosed through multiple tests that measure testosterone levels at different times.

The FDA approved testosterone replacement drugs only for the treatment of hypogonadism—not for gradually declining testosterone associated with aging. That didn’t stop manufacturers from advertising their products as “aging” solutions, however.

Should Healthy Men Use Testosterone?

Testosterone therapy has been found to help reverse hypogonadism, and has been a successful treatment for men who have the condition. Should it be used in healthy men, however, who are simply experiencing symptoms of aging?

Some doctors argue that many men with low testosterone levels can benefit from testosterone therapy even if they’re not diagnosed with hypogonadism. They do emphasize that men should be tested multiple times—something that hasn’t happened as often as it should, according to a 2014 study. Researchers found that 40.2 percent of U.S. men did not have a testosterone test in the 180 days before beginning therapy, and 50 percent had only one test.

Most concerning is the link between testosterone therapy and increased risk of heart attack and stroke. Over 2,000 men have filed testosterone replacement lawsuits in Illinois, because they listened to the advertisements and took testosterone to feel better, but then ended up suffering serious cardiovascular side effects.