Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, September 5, 1995 TAG: 9509070019
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: JANE BRODY
DATELINE: LENGTH: Medium
There is also no question that aging is accompanied by changes that can be signs of insufficient testosterone: Muscle size and strength declines, body fat increases, bones slowly lose strength-giving calcium and sexual performance wanes.
But it is still uncertain whether these bodily changes represent a condition in need of treatment or whether the changes are physiologically normal aspects of the aging process that men just have to accept, said Dr. Peter J. Snyder of the University of Pittsburgh School of Medicine.
It is an issue of growing importance as men now living into their 70s, 80s and beyond strive to maintain as high a quality of life as possible.
In women, the hormonal change at menopause is abrupt and its adverse effects on body organs are well-documented. Both the immediate and the long-term benefits of providing hormonal supplements are fairly well established, although possible risks are still incompletely explored.
But for men it will probably be years before doctors know whether they, too, can profit from hormone replacement and at what price. Well-designed studies are just getting under way.
For example, in about three years Snyder and his colleagues will have completed a scientific study of 100 men aged 65 and older who were randomly assigned to be treated with either a testosterone patch or look-alike dummy medication. The researchers are trying to determine whether raising the men's testosterone levels to that of a 40-year-old will result in an enhanced sense of well-being and improved bone calcium, muscle mass and strength.
``If we prevent the decline in testosterone with age, will that do more good or more harm?'' Snyder asked. ``In three years, we'll have the beginning of an answer, but it will be just the beginning.''
There are thousands of men, meanwhile, with a far more serious problem with testosterone than its gradual decline with age. Among them are adolescent boys and adult men whose bodies, for one reason or another, have never produced enough testosterone to induce such characteristics of male maturity as a beard and body hair, a muscular physique, adult-size genital organs, a libido and sexual potency to match.
Dr. Richard F. Spark, a specialist in male hormones and sexuality at Beth Israel Hospital in Boston, explained that these men may have either primary hypogonadism, in which testicular cells fail to produce testosterone, or secondary hypogonadism, in which the pituitary gland fails to produce adequate levels of the hormones that stimulate the testes to release testosterone.
At a recent meeting of the Endocrine Society in June, researchers presented evidence for major improvements in hypogonadal men treated with either injections of testosterone every two or three weeks or daily application of testosterone patches to the scrotum or to other parts of the body.
Both techniques have their pluses and minuses, but over all the patch has so far proved superior to injections in terms of patient acceptance and the ability to induce near-normal levels of testosterone throughout the day, day after day.
Even among men with clearly subnormal testosterone levels, there are some who do not respond well to treatment for impotence, Spark said. These include heavy smokers; men who are morbidly obese, whose metabolism results in low blood levels of testosterone even when normal amounts are produced, and men with diabetes.
by CNB