The prescription of testosterone supplements to men over 40 with “andropause symptoms” has increased over the past fifteen years. The subject is even the subject of a documentary this month on Tou.TV. THE Rumor detector however noted that the very existence of andropause is still debated.
The origin of the concept
In 1939, physician August A. Werner wrote in the Journal of the American Medical Association that many men go through a period similar to that of women during menopause. In 1944, doctors Carl G. Heller and Gordon B. Myers published an article in the same journal on how to diagnose this condition. They mention in particular that doctors are more and more often questioned on this, not because of Dr. Werner’s text, but since the publication, a few months earlier, of a text by microbiologist Paul De Kruif in the popular magazine Reader’s Digest.
A very different process from menopause
According to the United Kingdom’s National Health Service (NHS) website, the terms “andropause” or “male menopause” are misleading, since they suggest that the symptoms described by some men are due to a sudden drop in sex hormones, in a way similar to what happens in women.
However, the drop in testosterone which begins in men around the age of 30 occurs very gradually, as the Endocrine Society explained in 2014 in a text on the myths of male menopause. On average, testosterone levels decrease by approximately 1.6% per year, the American College of Physicians added in 2020 in its guidelines on prescribing testosterone supplements. Additionally, during menopause, a woman completely stops producing eggs and therefore becomes infertile. On the contrary, in men, sperm production does not stop with age.
Finally, all women will experience menopause one day or another, while not all men experience a significant drop in testosterone. For example, in the United States, it affects 20% of men over 60, 30% of those over 70 and 50% of those over 80, estimated the American College.
A consequence of aging?
Some young men may have a medical condition that prevents them from producing testosterone (Klinefelter syndrome, poor pituitary gland function, or an injury to the testicles). Doctors then speak of classic hypogonadism and treatment with a testosterone supplement is recommended, underlined in 2015 researchers from the American Food and Drug Agency (FDA) in a text where they expressed concern about the prescription of testosterone in older men.
However, in the case of an older man, no medical reason other than old age can explain the decrease in testosterone levels. This led to the emergence of the term “age-related androgen deficiency” (ALAD). Affected men may experience some of the symptoms normally associated with classic hypogonadism, FDA researchers noted. The diagnosis can, however, be complex, in part because there is no consensus on the criteria, concluded French scientists in a literature review published in 2020.
In 2010, British researchers studied 3,369 men aged 40 to 79 and confirmed that the more testosterone levels decrease, the more likely certain symptoms are to appear: reduction in the frequency of morning erections and thoughts with sexual connotations, erectile problems. , inability to walk more than a kilometer, loss of energy, sadness and fatigue.
From these observations, the researchers therefore established the necessary conditions for a diagnosis: presenting at least three sexual symptoms and having testosterone levels below 11 nmol per liter. Based on these criteria, they estimated that approximately 2.1% of men aged 40 to 79 would suffer from ALAD.
Some studies have shown that, for men with such a diagnosis, testosterone supplements may be effective in improving libido and erections, the Endocrine Society wrote in its 2018 clinical guidelines. They would also improve mood, but in a “modest” way. However, the American College of Physicians does not recommend prescribing testosterone supplements to older men for the sole purpose of improving energy, vitality, physical functioning, or cognition.
A controversial diagnosis
This is because the very existence of DALA remains controversial. In 2022, Australian endocrinologist David J. Handelsman went so far as to speak of an “invented” disease which contributes to pathologizing old age in humans. In another article published in 2021, FDA researchers also wondered whether the drop in testosterone that can occur with age would not rather correspond to a normal process and would therefore not necessarily be a disease that must be treated. French researchers also mentioned as possible causes poor lifestyle habits, stress, or a burnout. Certain illnesses, such as obesity or type 2 diabetes, can also affect testosterone levels.
Moreover, the British NHS points out that the symptoms men report as they age often have nothing to do with hormones. According to David Handelsman, longitudinal studies show that it is rather the accumulation of different diseases which is responsible for the drop in testosterone observed with age.
Finally, in 2015, FDA researchers believed that there was still no strong evidence that artificially increasing testosterone levels in older men would be beneficial. There are in fact few studies on the long-term benefits of testosterone-based treatments, the American College relaunched in 2020.
A marketing stunt
The fact remains that testosterone is increasingly prescribed, FDA researchers already observed in 2016. In the United States, testosterone prescriptions increased by 65% between 2009 and 2013. While in 2000, testosterone prescriptions corresponded to sales of $100 million, 13 years later they represented a market of 2.7 billion, reported American endocrinologist Shalender Bhasin in 2021.
And the marketing of testosterone products mainly targets middle-aged men. According to David Handelsman, testosterone has become a kind of anti-aging drug. It is also to justify its use by mature men that the industry would use terms like male menopause or andropause. The researcher therefore deplores that little is said about the commercial interests behind the promotion of testosterone.
Verdict
The drop in testosterone experienced by some men aged 40 and over is very different from menopause. If an association has been observed between certain symptoms, experts still do not agree on the presence of a real link. Financial interests could also influence the marketing around these products.
