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Improves libido // Lowers odds of heart attacks // Increases energy // Divides researchers over its connection to prostate cancer

Gaining Strength

By Timothy Gower // Photographs by Ramona Rosales // Summer 2012
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Ramona Rosales

One of the most talked-about books of 1945 was The Male Hormone, which extolled the wonders of testosterone. In it, popular science writer Paul de Kruif told of how treatment with testosterone—the primary male sex hormone, which had been identified just a decade earlier—could rejuvenate middle-aged and older men who complained of lost libido, flagging energy and sagging spirits. A review of the book in Time called it “a mixture of laboratory slang, movie-travelogue lyricism and man-to-man locker-room candor.”

The Male Hormone arrived as a debate raged in medicine: Was there a male version of menopause? And could testosterone therapy allow aging men to rediscover sexual potency and virility? Many doctors eagerly explored the hormone’s potential for these and other uses, ranging from relieving heart ailments to “curing” homosexuality. Other physicians were dubious. In the early 1940s, research by University of Chicago physician Charles Huggins (who would win the Nobel Prize for his work) found that depriving men of testosterone by castration (through surgical removal of the testicles or with estrogen, which blocked testosterone’s effects) slowed the progression of aggressive prostate cancer, and that spawned a corollary theory: Testosterone must fuel growth of the disease.

Within a decade, scientific interest in testosterone began to dwindle. Many men disliked testosterone treatments, which required frequent needle injections and often didn’t relieve their primary complaint, erectile dysfunction. Meanwhile, by the mid-1950s, medicine began to view the woes of aging males in a new light, says medical historian Elizabeth Watkins in the forthcoming Aging Men: Medicine and Masculinities (Routledge, 2012). Hormones were no longer seen as the problem; loss of libido, low energy and other symptoms “resulted from a psychoneurotic condition, brought on by the social stresses and economic pressures of modern life,” Watkins writes. Tranquilizers soon became the treatment of choice, and discussion of testosterone replacement therapy “virtually disappeared from the medical literature” for the next 40 years, according to Watkins.

Fast-forward to the present: Testosterone replacement therapy is back and booming. The number of annual prescriptions for TRT in the United States doubled during the past five years, with sales of injections, gels, skin patches and even pellets implanted in the buttocks topping $1.64 billion in 2011, according to IMS Health, a health-care-industry market research firm. Part of this surge is attributable to advertising, including television commercials and print ads that ask, “Is it low T?” But there also has been a wave of research suggesting that middle-aged and older men with low testosterone levels—more than 8 million Americans overall, including one in four men older than age 70—can experience a striking pattern of symptoms that may result from the deficiency. Some physicians insist that restoring hormones to youthful levels can allow a man to regain his former sense of masculinity—and possibly prolong his life.

“For 60 or 70 years, we’ve thought about testosterone as being purely about sex,” says Abraham Morgentaler, director of Men’s Health Boston, a clinic for men with low testosterone and other health issues, and associate clinical professor at Harvard Medical School. But Morgentaler believes conventional wisdom is about to change. He and others point to a growing body of research indicating that men with “low T” suffer more than fatigue and disappointment in the bedroom. Studies also have found an increased risk for heart disease, type 2 diabetes, depression, falls and hip fractures, anemia and Alzheimer’s disease. Morgentaler thinks it’s becoming impossible to ignore the notion that low testosterone is a threat to overall health.

Yet many other physicians question the growing popularity of TRT, pointing out that ebbing libido, erectile dysfunction, low energy and other symptoms can be brought on by many conditions unrelated to male hormones. More ominously, they argue, the risks linked to testosterone, especially the threat of triggering prostate cancer cells to grow and spread, outweigh the potential benefits for most men. Skeptics also tend to draw parallels between TRT and hormone replacement for women—a therapy that the medical establishment embraced for years before a landmark study raised questions about heart disease and cancer risks.

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1.“Testosterone Therapy in Men With Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline,” by Shalender Bhasin et al., Journal of Clinical Endocrinology & Metabolism, June 1, 2010. From the world’s largest organization of endocrinologists, recommendations for prescribing therapeutic testosterone for the treatment of symptoms associated with low androgen levels. Essential diagnostic criteria: ‚“consistent‚” symptoms and ‚“unequivocally low‚” serum testosterone.

2. “Testosterone Treatment of Older Men—Why Are Controversies Created?” by Ronald Swerdloff and Christina Wang, Journal of Clinical Endocrinology & Metabolism, Jan. 1, 2011. An editorial that concisely summarizes the reasons testosterone therapy is still hotly debated more than 70 years after its introduction, such as the lack of a clear definition of testosterone deficiency and the fact that many men with “low T” have no symptoms.

3.Testosterone Dreams: Rejuvenation, Aphrodisia, Doping, by John Hoberman (University of California Press, 2005). Sports historian Hoberman offers a scholarly but lively social history of testosterone.

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