As the American population ages, baby boomers are confronted with a number of troublesome age-related diseases.  Many are scrambling to hold onto their health and youthful vitality.  Retirement is not what is once was.  More people want to remain active and engaged with life, not just sitting around with a fishing pole in their hands.  And, they certainly do not want to suffer the slow decline in physical and cognitive function that afflicts far too many in nursing homes.  Although a number of factors must be considered, including living a healthy lifestyle, mounting scientific evidence points to diminished hormones as a previously under recognized, yet modifiable factor in the aging process.

 Do our hormones decline because we get old?  Or do we feel old because our hormones decline?  One of the most pronounced health issues facing boomer men is plummeting testosterone levels.  Beginning in their mid to late 30’s or early 40’s, men lose 1% – 3% of their testosterone per year.  There is no abrupt drop off like women in menopause, but the decline for men continues throughout the remainder of their lives.  Insufficient testosterone levels can lead to a number of debilitating conditions with signs and symptoms including erectile dysfunction, low libido, impaired physical performance and frailty, decreased vitality, reduced bone mass, decreased muscle mass and strength, unfavorable lipid profiles, increased fatigue, sleep disturbances, depression, anemia and impaired cognitive function.

 With studies like the recent Massachusetts Male Aging Study[1] demonstrating an overall reduction in average testosterone levels for American men over the last 30 years, and studies linking lower testosterone to increased risk for cardiovascular disease, obesity, type-2 diabetes, metabolic syndrome, osteoporosis and premature death, there is renewed interest in testosterone therapy for men to improve quality of life.  The Health in Men Study published this April found that older men with relatively low testosterone levels were more likely to be frail or to become frail over the next several years than men with normal testosterone levels.[2]

 The National Institutes of Health and the National Institute on Aging have undertaken a new study called the Testosterone Trial.[3]  This study began in 2009 and seeks to determine if testosterone treatment for one year compared to placebo will be associated with improved walking speed, improvement in sexual activity, improvement on the vitality scale and verbal memory test, and anemia correction.  It will include 800 men aged 65 or older with low testosterone and one or more of these symptoms: impaired walking or physical function, low vitality, cognitive dysfunction, low sexual function, or anemia.

 It is estimated that more than 4 million men over age 45 in the United States have low testosterone, and only a small percentage are receiving treatment.  Many physicians hesitate to offer testosterone replacement to men with the misguided belief that testosterone causes or fuels prostate cancer.  Unfortunately this misconception has been perpetuated in medicine for so long that it had come to be accepted as true.  It certainly seems counterintuitive to link the two when the incidence of prostate cancer increases with age, while testosterone levels decrease.  Several extensive reviews of the medical literature, including an analysis out of Harvard University have revealed no such association.   Lack of consensus about the diagnostic criteria also causes confusion.  Many doctors will not treat men with all of the symptoms of low testosterone, even if they are near the rock bottom of the normal range, because it is still within that range. Another factor causing apprehension is the abuse of steroid hormones at unnaturally high levels by professional athletes for performance enhancement.

 What is the bottom line?  Any man over 40 or 50 that feels off his game, run down or is experiencing any of the symptoms of low testosterone should have a thorough evaluation.  I recommend seeking out a physician experienced in preventive health and hormone therapy for men.  Rather than narrowly focusing on just your hormone levels, a comprehensive program will expose your total health picture and help you move toward achieving optimal health. 

[1] O’Donnell AB, Araujo AB, McKinlay JB. The health of normally aging men: The Massachusetts Male Aging Study.  Exp Gerontol. 2004 Jul;39(7):975-84.

[2] Hyde Z, Flicker L, et al. Low Testosterone Predicts Frailty in Older Men: The Health in Men Study.  J Clin Endocrinol Metab, April 2010