Would older men and women be better off with a bit more testosterone?

Book Review:  Testosterone is your friend by Roger Mason.

This slim volume, written by research chemist Roger Mason, reviews  evidence for testosterone replacement in both  men and women. Up until the age of 30, both genders do pretty well, but after that it is a slow trundle downhill as far as our sex hormones go. By our 50’s men produce more oestradiol than their same aged wives do, and a multitude of problems that we consider “just normal ageing” develop.

Men don’t get problems from high levels of testosterone,  but do get problems when the levels go too low.  Women do best with  mid range levels about 2.1 free testosterone. Levels of 1-3.2 are considered normal range in the UK.

Should you wish to supplement levels  sublingual or transdermal preparations work well,  but injected, implant and oral tablets do not.

Too low levels of testosterone cause obesity, diabetes, osteoporosis, heart and artery disease, cancers, memory loss and sexual dysfunction. When levels are normalised to those found in your average 30 year old for both genders, benefits include an improved all cause total mortality, increased lean muscle mass, lower cholesterol, stronger bones, lower body fat, and higher HDL.  Mood, blood sugars, energy and sense of well being all improve. Prostate enlargement and prostate cancer can be reduced by replacing testosterone in men in good time. Skin, hair and immunity all improve.  Blood pressure is improved in women if the mid range level  is achieved. Testosterone reduces seizure threshold in epileptics.

Studies are reviewed which indicate that all these assertions are valid. So why is testosterone replacement therapy lagging behind so much compared to oestrogen replacement? Indeed the only testosterone preparation licenced for women in the UK was taken off the market in the last couple of years due to being a marketing failure.

As a GP I can say that testosterone replacement for men is getting off the ground but not in the pro-active way that oestrogen is given to peri-menopausal and post meno-pausal women. Instead we wait till problematic symptoms occur eg breast enlargement in men, diabetes in men of normal weight, or sexual dysfunction occurs. Then we test. Then we refer to over subscribed clinics and the man eventually gets prescribed something suitable. It is a true case of shutting the barn door after the horse…..etc.

The main thing that put me off prescribing for men was that the fine print said that I had to do a digital rectal examination on such men every six months in order to detect possible prostatic cancer. From what Mr Mason says, it would look as if testing and treating men over the age of 40 could make a big difference not just to prostate health but for a very wide range of health problems. It should be remembered that these diseases all seem to have their own very expensive screening programmes, drug and surgical treatments in place. Perhaps a single bullet aimed at the core problem would be less expensive overall?

When it comes to women, after the menopause there is a dwindling amount of testosterone and secreted by the ovary and after a surgical removal of the ovaries or hysterectomy there is rapidly none. The adrenal glands are able to secrete some testosterone, but not enough. Collagen loss, bladder problems, wrinkles, weaker bones, loss of muscle and gaining of fat and all the rest follow on. There is increasing interest in adding testosterone into HRT prescriptions but at present women need to use preparations licenced only for men and not all GPs are therefore willing to prescribe.

In my own practice, several of us are using these preparations and checking our prescribing with blood tests done at monthly intervals till we hit the right dose. As a rough guide, men need 8 squirts of Testogel daily and women need 3. This will usually give deficient men and women adequate levels, but since this is not a developed area, follow up blood tests are needed to individualise the dose.

What about our three lovely ladies here? They are just having a natter about their new year resolution. They have been off to the  gym weight training for an entire month now and are a bit disappointed with their results. The middle one is telling the blonde that at least her bicep is coming along better than her glutes. No doubt they are hacked off that it is so much easier for their boyfriends with all that testosterone running around.   It’s so unfair!!!