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‘Low T’ and the medicalization of male aging

“In the age-old tradition of snake oil peddlers and traveling medicine shows, [testosterone replacement therapy] is but the latest elixir from the fountain of youth,” John-Manuel Andriote writes.

In spite of claims made by drug sellers, truly low testosterone only afflicts 0.1 percent of men in their 40s and just 5.1 percent of men in their 70s.

Medical writer John-Manuel Andriote has written a terrific article for the Atlantic magazine on the medicalization of low testosterone levels in men.

If you or anybody you know is or has been tempted to take the testosterone gels, patches and other products that are now aggressively marketed on TV and elsewhere to men (and to their doctors), this is a must-read piece.

“In the age-old tradition of snake oil peddlers and traveling medicine shows, [testosterone replacement therapy] is but the latest elixir from the fountain of youth,” Andriote writes. “Offering a heady brew of hope and hype distilled at the drawing boards of advertising agencies, tubes of testosterone are the latest wares for the unwary.”

There is, as Andriote explains, a medical condition characterized by low testosterone — known as hypogonadism or hypotestosteronemia — but it affects a very small number of men. Only about 0.1 percent of men in their 40s would meet the diagnostic criteria for this condition — a number that climbs to just 5.1 percent among men in their 70s.

‘Scientifically unproven’

But the vast majority of older men who are taking testosterone drugs do not have hypogonadism. Nor are their testosterone levels abnormally low, as Andriote explains:

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Testosterone levels in men normally fall by only 1 to 2 percent per year after age 40. [But] “low T” is anything but inevitable. BMJ’s Drug and Therapeutics Bulletin says that around 80 percent of 60-year-old men, and half of those in their eighties, have testosterone levels within the normal range for younger men. It concluded, “The evidence that an age-related reduction in testosterone levels cause specific symptoms is weak.”

The Food and Drug Administration (FDA) meanwhile has not approved testosterone use to improve strength, athletic performance, physical appearance, or prevent aging. And a 2004 report from the Institute of Medicine (“Testosterone and Aging: Clinical Research Directions”) called TRT for age-related testosterone decline a “scientifically unproven method.”

“A proportion of older men will predictably have testosterone concentrations below the normal range of healthy young men,” wrote BMJ deputy editor Tony Delamothe, in a 2012 commentary. He added, “It seems a bit harsh to turn an age-related phenomenon into a disease, but that’s what’s happened.”

Serious health risks

Taking testosterone has serious health risks, as Andriote also points out:

The commercials [for testosterone products] don’t mention a 2009 study in the New England Journal of Medicine wherein a group of men on testosterone replacement therapy had more than four times the number of cardiovascular problems — so many that the study had to be halted.

They also don’t make clear how risky exposure to testosterone gel is for others — female partners, children, even pets. The gel is actually notorious for transferring to others. It can cause excess hair to grow on women’s faces and arms, deepen their voices, interrupt menstruation, and make them anxious and irritable. In children, exposure to testosterone gels and creams can cause premature puberty and aggression. And in pets, it can cause aggressive behavior and enlargement of the genitalia.

Commercials do mention other potential side-effects for the male user, calling them “rare,” including swollen and painful breasts, blood clots in the legs, increased risk for prostate cancer, problems breathing during sleep (sleep apnea), change in the size and shape of the testicles, and a low sperm count. But you’re not supposed to focus on the details. Instead, just think of the energy you’ll have. The great sex you’ll have. And the muscles. It will be a veritable second adolescence as your aging body bursts into new bloom.

Sales of testosterone “replacement therapies” in the United States reached $1.6 billion in 2011 and are expected to triple to $5 billion by 2017, according to a Bloomberg Businessweek news report.

Before you plunk down your money, I suggest reading Andriote’s article. You’ll find it on the Atlantic magazine website.