This is a story about sex, drugs and sports—things we love to talk about. And, for extra spice, porn and cancer.
Pharmaceutical companies are aggressively marketing drugs to combat low testosterone—“low T’ in the ads—in older men, and they are doing it with the same enthusiasm (and big budgets) that they market rejuvenating creams and Botox to aging women. According to USA Today, prescriptions of Androgel and other testosterone replacement therapies (available as gels, patches and injections) “have increased nearly 90 percent the past five years.” Worldwide, annual sales are approaching $2 billion. And there’s plenty of room to grow: in America alone, drug companies see the potential for another 15 million customers.
Clearly, the potential is much greater. Why? Because populations in developing countries are aging, and testosterone naturally declines as a man ages, and that decline is an important contributor to everything a man dislikes about the flipping of calendar pages. In theory, testosterone gives you energy, revs up the libido, and helps you fight fat while it allows you to keep up with the younger guys on the court. It improves your mood; it increases muscle mass.
All of which sounds terrific. Listen closely and you might hear a few reedy-voiced protests against testosterone replacement on the grounds that it is more “medicalizing” of old age, by which we think they mean it is turning into a symptom what should be seen as part of a normal latter-stage fade-out.
To which we say, please medicalize us. Sure, a drop in testosterone is natural. So is body odor and tooth decay. And sure, it’s your call if you want to go gentle (and ripe and toothless) into that good night. But when the sun starts to set on many of the blessings in life, most of us would willingly build a bonfire of our 401ks to hold off the dying of the light.
A more sensible criticism of hormone replacement gels and injections is that they might not make any difference. The largest study so far involved just 230 patients in the Netherlands, so you don’t want to generalize too much, but it “found no improvement in muscle strength, cognitive thinking, bone density or overall quality of life among men taking testosterone.”
(That gives marketers precious little to work with in terms of what we call facts, a situation that is most easily corrected with a lot of splash, promotion and repetition; this could explain why the ad-buy for testosterone replacement drugs “has risen more than 170 percent in the last three years.”)
If the drugs gave even a slight possibility of some improvement, with little or no downside other than the cost, that might be enough to justify taking them. They would be like a pharmaceutical Powerball ticket (pun not originally intended but obviously we’re keeping it in so we think it’s mildly amusing). Sadly, the hormones could actually lead to some unpleasant side effects. Like prostate cancer. Which could mean your fade-out becomes a black-out.
“In 2010, researchers at Boston University’s school of medicine halted a large study of testosterone in senior men because patients taking the hormone were five times more likely to suffer a serious heart event, including congestive heart failure, than those taking placebo. A review of 19 testosterone trials in 2006 found that prostate cancer was significantly higher among men taking testosterone.”
(To all this, women respond with a big, “So you weren’t paying attention, ten years ago, when we found out that estrogen replacement was giving us heart attacks? And breast cancer? And strokes? Seriously?”)
All this might suggest that men have to pick between two unacceptable choices: the exploding lottery ticket of testosterone replacement or passively watching as the source of their mojo dries up.
Maybe not. A few years ago, Newsweek/Daily Beast noted that some of the same benefits of drug therapy might be achieved by more natural methods: “In humans, German researchers have found that just having an erection is enough to spur testosterone levels. It makes no difference whether a man is watching sex on a screen or having it in real life, his testosterone levels will go up. Just having an erection, in fact, is enough to spur production.”
As therapies go, this sounds reasonably agreeable. We haven’t seen anything that quantifies this effect—no details on how much testosterone is produced, or what the long-term affect might be—and for those without a partner, spending too much time with pornography sounds almost as grim as a life filled with low-T induced naps and flabbiness. But it’s still probably better than prostate cancer.
The risk-benefit picture could be clearer a few years from now, in 2014, when the U.S. National Institute on Aging is expected to release results of an “800-man trial to definitively answer whether testosterone therapy improves walking ability, sexual function, energy, memory and blood cell count in men 65 years and older.”
Image: Official White House photo of First Lady Nancy Reagan with Mr. T, Christmas 1983, via Wikipedia Commons.
