Treating Male Menopause Could Prevent Diabetes and Heart Disease

Testosterone top-ups may combat low sex drive and depression as well as prevent heart disease and diabetes

Women have been using hormone replacement therapy for decades to combat the symptoms of menopause. Now men could be offered the same treatment to prevent diabetes and heart disease when they reach 50.

Professor Bruno Lunenfeld, president of the International Society for the Study of the Ageing Male, said at an international conference yesterday that giving men testosterone top-ups when their natural hormone levels dropped with age could keep them healthy and allow them to lead fuller lives.

At the moment only a few thousand men in the UK are prescribed hormone replacement therapy (HRT) to combat lack of energy, sleepiness, low sex drive, erectile dysfunction and depression. But some experts believe HRT for men could also help prevent more serious illnesses including heart disease and diabetes.

They believe the decline in male hormones such as testosterone, growth hormone and the thyroid stimulant androsterone can contribute to a build-up of fat around the stomach, which puts men at higher risk of suffering from chronic disease.

Lunenfeld, an emeritus professor at Bar-Ilan University in Israel, says men could be given a simple questionnaire to find out if they were suffering symptoms of testosterone deficiency. If the diagnosis was confirmed by a blood test, HRT would be offered -- unless the man was shown to be at risk of prostate cancer, which is believed to be aggravated by hormone supplements. A prostate-specific antigen (PSA) test can detect the symptoms of prostate cancer six years before the disease appears.

'If men were routinely asked these questions when they reached the age of 50 and the doctor suspected they suffered from hormone deficiency rather than straightforward depression, a blood test would be taken to measure testosterone,' Lunenfeld said.

He estimated that around 20% of men between the ages of 50 and 60 would benefit from testosterone replacement. This rose, he said, to around 40% of men between 60 and 70 and more than 50% of men over 70.

'We know from some very good studies that decrease of testosterone leads to decrease of lean body mass and to an increase in fat around the belly,' he said. 'We also know from excellent random, controlled studies that giving these men testosterone increases muscle mass and decreases visceral fat storage.

'The increase in central fat stores increases health risks such as diabetes, hypertension and cardio vascular disease,' he said. 'Interventions such as hormone replacement therapy may alleviate these debilitating conditions.'

Professor Lunenfeld was speaking at the 11th Congress on Human Reproduction in Montreal. The prospect of routine prescription of testosterone was immediately welcomed by Dr Malcolm Carruthers, chairman of the London-based Andropause Society, which was set up to raise awareness of the male menopause.

'It is becoming recognized that testosterone is certainly not bad for the heart and arteries, and is probably good,' he said. 'As we now need to work into our 70s to secure our pensions, it is good to be mentally active. There is evidence now that testosterone may be as useful as oestrogen in maintaining alertness.

'I think there are high- testosterone men who only function when their testosterone levels are high,' he added.

But other experts caution against the widespread prescription of HRT for men. Several large-scale trials have now been launched into the male menopause to discover if it exists, if HRT helps and if there are damaging side-effects.

One of these is being carried out at Aberdeen University. By this summer 400 men will have been recruited to the trial, and most participants have already started taking their year's supply of hormone replacement drugs.

All the men are over 50 and have been identified as suffering from low testosterone levels. They have been split into four groups, three of which are being given varying amounts of testosterone. The fourth is being given a placebo.

Dr Mark Hamilton, consultant gynecologist at Aberdeen Maternity Hospital, is leading the trial. He believes it is important to wait for the results before offering testosterone to all middle-aged men. 'The difficulty is that the kind of symptoms that we might ask about are not specific to testosterone deficiency. Many people who feel lethargic, are suffering from sleep loss or are having sexual difficulties will have normal testosterone levels. The difficulty we have is deciding whether giving them testosterone will help.

'We will be looking at whether there are hazards such as increased risk of prostate cancer or whether giving testosterone might have a damaging effect on lipid levels in the blood which could be associated with the risk of cardiovascular disease.

'At the moment there is confusion over the evidence about what it might do to cardiovascular risk. We need to do the clinical trials properly first.'

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