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Therapies could battle male menopause
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Copyright 1997 Nando.net            Copyright 1997 Scripps-McClatchy Western

SACRAMENTO, Calif. (August 6, 1997 00:15 a.m. EDT) -- With millions of baby
boomers sailing into their 40s and 50s, researchers are looking for
therapies to counteract the effects of "male menopause" to preserve
strength, vitality and independence in later years.

In the past, researchers -- the preponderance of them men -- had scant
interest in considering the decline of the male sex hormone, testosterone,
because they didn't want to believe such a phenomenon existed, said Dr.
John Morley, professor of medicine at St. Louis University Health Sciences
Center.

"It was a macho thing. It was OK to study the decline of estrogen in
females but not testosterone in men," said Morley, lead investigator in the
first long-term study to demonstrate the positive effects of testosterone
replacement in older men.

Morley and his team found that although individuals vary, generally
testosterone levels begin a slow, gradual descent at about age 40, and by
age 60 levels drop around 10 percent a decade.

The syndrome is usually associated with a decrease in libido (sex drive),
an inability to sustain an erection, a decrease in energy and strength, and
changes in visual-spatial ability ("a reason baseball players retire"), he
said.

The goal of at least five studies funded by the National Institute on Aging
isn't to restore men to their youthful prowess or to develop therapies to
combat male menopause, "which we aren't even sure is something that
exists," said Dr. Chhanda Dutta, director of Musculoskeletal Research at
the NIA.

"Our interest is really geared toward improving physical function, muscle
mass and strength," she said. "If we can preserve those things in old age,
maybe we can reduce the risk of chronic disease as well as maintaining
physical independence."

Dr. Shalender Bhasin, chief of endocrinology, metabolism and molecular
medicine at Charles R. Drew University of Medicine and Science in Los
Angeles, echoed the point: "Investigators are interested in its
(testosterone's) use because frailty is a very major public health problem
with the elderly and one that greatly impacts quality of life and cost of
caring for these people. The difference in cost in caring for an ambulatory
person versus a bedridden one may be 100-fold."

Recent interest in the effects of male menopause -- most researchers prefer
the term "andropause" -- is fueled by demographics and economics.

"Baby boomers are interested because they are entering that stage of life.
And drug companies see a large market, so they are interested," Bhasin said.

In one of three recent studies, Morley and his team found that for older
men with lower than average levels, testosterone replacement improved
muscle strength and increased hemoglobin (a protein in red blood cells that
carries oxygen from lungs to tissues).

Morley concluded that replacements may play a role in treating or reversing
frailty, but that it's not a harmless therapy and must be carefully
monitored because of the risks.

For example, there is concern that testosterone replacement may stimulate
the growth of microscopic cancers housed in many older men's prostates,
Bhasin said. A yet-to-be published study by Morley's team found no such risk.

Unlike menopause, which all women experience when the ovaries fail,
resulting in a drop in estrogen and end of menses, andropause is subtle and
arbitrary. In some men, its occurrence is minor; in others, almost total.
It can affect one man at age 60 and another at 85, Urban said. Generally,
however, at about age 60, men begin a significant decline in testosterone
levels. About 20 percent of older men retain levels equivalent to young
men. For the remaining 80 percent, levels fall to less than half that of
young men, he said.

According to Dr. Randall Urban, an associate professor of internal medicine
at the University of Texas Medical Branch at Galveston, who headed a recent
study, andropause has four symptoms:

- A decrease in testosterone.

- An increase in the gonadatropins, the two hormones made by the pituitary
gland that stimulate the testes to make sperm and testosterone. The
increase indicates the testes are not working well.

- An increase in feminization, primarily in breast tissue development.

- An increase in fatigue or loss of strength.

Urban is studying the metabolic differences in muscle before and after the
hormone therapy. The next step, he said, is to find out if improved muscle
strength translates to better functioning. In other words, "Will the older
man make it up the stairs better at home?"

But testosterone replacement isn't a panacea for an aging male population's
health problems, Urban said.

"The bottom line is exercise to strengthen muscles is a much better
strengthener. It may be difficult to get elderly people to stick to a good
exercise program, so this may be an adjunct. But if we could get everyone
to exercise regularly, that would do more for muscle strength than therapy
alone."

By KATHRYN DORE PERKINS, Sacramento Bee
<http://www.nando.net/newsroom/ntn/health/080697/health37_6584.html>
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