If women are from Venus and men are from Mars is that because there is so much more testosterone on Mars?
“Every difference that you can possibly think of between a man and a woman is due to testosterone,” said Peter Snyder, a University of Pennsylvania endocrinologist.
Since 1935, when the male steroid sex hormone was first isolated, it has been held accountable for differentiating men from women by determining men’s secondary, or physical, characteristics — their deeper voices, muscle growth, healthy bones, sex drive and sometimes aggression. It has been blamed for everything from the moods of teenage boys to the search for a trophy wife to war. Testosterone exists in women but in a much smaller quantity.
Beginning at age 40, researchers say, the average male loses about 2 percent of his testosterone each year. Whether having more or less testosterone at any time and whether the quantity circulating through a man’s bloodstream influences a midlife crisis has become a popular topic for everyone from medical experts to the guy next door. And many men, especially those who experience impotence, wonder whether their testosterone levels even fall within the normal range.
This month, Unimed Pharmaceuticals Inc. in Deerfield launched a testosterone product called AndroGel in easy-to-tote 5-gram foil containers the size of single-serve ketchup packets. Rubbed daily on an arm or abdominal area, the gel’s testosterone is absorbed quickly into the skin and seeps into the blood.
Some clinical trial participants already are reporting good results. Don Gelles, 57, a California pharmacist who experienced hot flashes, impotency, lethargy and irritability, says some symptoms have disappeared since he started using it.
“I still have mood swings but they’re not as high and low. The impotency also improved though it’s not like I’m in my 20s. I feel better about myself,” Gelles said.
For those starting to worry, MedLean Inc. in Duxbury, Mass., already produces a home test that utilizes saliva to determine testosterone levels.
Part of the more open attitude is surely due to male and female Baby Boomers’ greater willingness to seek quicker fixes for their problems as they’ve aged.
“Women became more open about discussing their problems, and now want to discuss men’s problems as part of their relationships,” says Dr. Larrian Gillespie, a urologist/gynecologist and author of “The Menopause Diet” (Healthy Life Publications, $17.95). “We used to think that women after 50 never had sex, but that’s not true. They enjoy it and need their partners, which spurs openness about male sexual dysfunction.”
Yet despite research and a more open mindset, there’s still no consensus about basic testosterone-related questions: What can — and can’t — it do physically and emotionally? What’s considered a normal amount or range? How is it best measured? When does it start declining? How effective will increasing it be?
Dr. Kevin McVary, an associate professor of urology and director of sexual dysfunction at Northwestern University Medical School, thinks that testosterone has little impact on sexual function. Yet it gets labeled the culprit because it decreases gradually as a man ages, which is the exact time when other problems may surface, he says.
“Things that affect the heart affect sexual function. The neural processes affect erection, diabetes and cholesterol,” McVary says. “But blaming testosterone for a host of ills doesn’t hold pathologically. Low levels may support the idea of lethargy, but that doesn’t translate into the male version of menopause,” known as andropause for the male androgen hormones, he says.
Dr. Richard F. Spark, an associate clinical professor of medicine at Harvard Medical School and author of “Sexual Health for Men: The Complete Guide” (Perseus Publishing, $20) concurs. “Testosterone gradually declines in most men at age 50, but it’s a subtle decline, and even in a group of 80 to 100 men only 30 percent have a below normal range. A man who may be difficult and crabby in his mid-50s may always have been difficult and crabby. Not all symptoms relate to testosterone. Depression may reflect a bona fide depression. With aging, there’s a collective impact rather than one system declining,” he says.
Furthermore, there’s another big difference between men and women.
“When women age, there’s a point when ovaries stop functioning and there are no ova. In men, there’s no comparable hormonal shift. Testicles still produce testosterone, just not with the same vigor. It wanes, but never to zero,” Spark says.
But Ellen Kamhi, a nurse and co-author of “The Natural Medicine Chest” (M. Evans, $14.95), disagrees and thinks the marked decrease of testosterone after age 50 can fuel a midlife crisis.
“It’s unfortunate for men that their cycles are not as recognized when they experience many of the symptoms as women — a loss of interest in sex and mood swings,” she says.
So, back to one of the more pressing questions: What’s considered a normal amount? There’s no single figure. From 300 to 1,000 nanograms per deciliter of serum has been cited by doctors for decades, despite being such a wide range. For women, it’s a narrower span of 50 to 60 nanograms.
Several factors make it difficult to even determine “normalcy.” First, it depends on comparing men of the same age and healthfulness, says Dr. Andre Guay, endocrinologist and director of the Center for Sexual Function at Lahey Clinic outside Boston. “Some say 200 is the norm for men over 70 but 300 is low for a 30-year-old,” he says. “We have data from the Massachusetts Male Aging Study, but we don’t have enough to know what’s normal at any age.”
Second, in addition to the number or range, there’s disagreement about the best testosterone measurement. Many, such as Dr. John Kowalczyk, a Los Angeles urologist and specialist in treating erectile dysfunction, prefer initially to test “total” testosterone, how much is present in the body at any given time. If such levels appear to be low, he looks for “free testosterone,” a more active, but less prevelant, form of testosterone. He doesn’t advocate screening at first for this amount because it’s more expensive, complicated and unnecessary if the total is normal.
Gillespie thinks a still better figure is the ratio between testosterone and estrogen because the higher the estrogen in a man, the lower the free testosterone and the greater his chance for disease such as diabetes, heart attack and osteoporosis. Nevertheless, she says it’s too early to cite an ideal ratio. “Studies haven’t been done for a long enough period,” Gillespie says.
Spark, however, thinks any ratio is unimportant unless a man is plagued by too much estrogen as evidenced by a symptom such as breast enlargement, or gynecomastia.
While this debate continues, still another goes on: Is more testosterone better? McVary believes that increasing the amount for men who fall into the normal range provides marginal benefit and worse, a potential risk to enlarge their prostate and activate prostate cancer, if present. It may also cause fluid retention, congestive heart failure and an increase in red blood cells.
An exception, McVary says, is for men with low testosterone, known as hypogonadism. Increasing their androgen levels tends to improve their emotional mindset and libido, he says.
But Dr. Richard H. Cohen, who works for MedLean, says such thinking doesn’t reflect the most cutting-edge research and therapy because it addresses only the small percentage of men who are very deficient. “It doesn’t address the men who had high levels in their youth, which subsequently declined due to age, stress and life events. Even though they haven’t reached a hypogonadal stage, their lives can still be improved by restoring testosterone. We tend to treat this issue only as a disease when it’s also a matter of lifestyle,” he said.
At the same time, Cohen does not advocate men whose levels have decreased use testosterone or steroid therapy to bulk up.
So, are we better off with what we now know about testosterone and its mythic powers? Again, there’s no unanimity.
Ronald F. Levant, dean of the Center for Psychological Studies at Nova Southeastern University in Ft. Lauderdale and author of “Masculinity Reconstructed” (Penguin, $13.95), believes that focusing on gender to differentiate men and women ignores the critical influence of parents who condition their children emotionally from a young age.
“We tell boys early on not to express vulnerability. We tell girls not to express anger,” he says. “But as men get older, their restricted emotional involvement wears thin, and men in their 40s and 50s feel utterly burned out and unsatisfied in being married to their jobs. They look for a quick fix in a little pill to change their lives because it’s easier than relearning behavioral patterns.”
Robert E. Dudley, president and CEO of Unimed, thinks that having more information about testosterone makes it clear that a lower amount may be a primary cause of problems in men’s health, but far from the only one. Kowalczyk agrees that increased knowledge allows physicians to place all information in perspective so they can treat the whole patient. But he cautions, “Nothing will make a middle-aged or older man feel the same as when he was 25.”
