The male menopause gets the testosterone treatment

Compared to the female menopause, which heralds rapid changes in a woman's physiology, the male 'change' is a gradual and often imperceptible transition.

As male testosterone levels begin to decrease from the age of 30 by about 2 per cent a year, the associated changes are slight and the very idea of a male menopause has often been derided. Consequently, there has been relatively little research carried out on menopausal symptoms in males. Now, however, researchers are beginning to attribute a whole range of symptoms to testosterone deficiency, from depression and loss of sex drive to abdominal weight and cardiovascular disease.

Most men will experience testosterone loss incrementally, with no ill-effects. However, it is believed that up to 25 per cent of men in their 60s experience sharp drops in testosterone levels resulting in depression, loss of muscle mass and bone density, forgetfulness, irritability and reduced libido. A Testosterone Deficiency Advisory Board has been set up in Ireland to raise awareness among GPs of testosterone deficiency and its symptoms.

A growing number of GPs are prescribing Testosterone Replacement Therapy (TRT), in the form of a topical gel, to older men describing some or all of these symptoms. Research into the efficacy of TRT are still confined to small test groups, but, anecdotally, the results are promising, says GP Andrew Rynne. Dr Rynne has prescribed testosterone replacement gel for a number of visitors to his surgery in Clane.

"Men visit doctor's surgeries and describe feelings of depression or lack of energy - often they won't mention loss of sex drive or erectile dysfunction even if they have these symptoms too. The GP may end up prescribing anti-depressives when testosterone replacement may be the answer. We are trying to plant a seed in the minds of Irish GPs, to consider testosterone deficiency as a possible cause of many complaints in older male patients."

According to the Testosterone Deficiency Advisory Board, many men may be living with avoidable symptoms and writing them off as old age. Mild to severe depression, decrease in muscle strength, increase in body fat, poor quality erections, reduced cognitive powers and raised cholesterol are part of the suite of symptoms associated with testosterone deficiency, according to the association.

The most popular form of TRT is a gel called Testogel which, when applied to an area of skin on a daily bases, raises testosterone in the blood to levels similar to those of much younger men.

Clinicians are divided on the efficacy of TRT treatment, however. The net result of raising testosterone in the system is an enlargement of the prostate gland. For men with prostate cancer, this is not a desirable outcome.