NEW YORK, Sept. 17, 2012
While there is some skepticism about male menopause there is no question that age-related changes in men impact testosterone level. Between pharmaceutical marketing and our sometimes-carefree trust in prescription medicine, a drastically climbing number of men are turning to androgen therapy for prostate cancer. Prostate cancer treatment expert and leading robotic prostatectomy SMART surgeon, Dr. David Samadi, urges men and their physicians to use hormone replacement therapy (HRT) with caution.
“Increased risk of prostate cancer is a very possible long-term side effect of testosterone replacement therapy,” he says. “It concerns me that young men in their mid-30s or early-40s may count on testosterone for a boost in energy or sexual prowess and get much more than they bargained for in the long run.” Dr. Samadi refers to the link between testosterone and prostate cancer risk.
Male menopause, or andropause, symptoms occur much more gradually than menopause symptoms in women. Around age 35 or 40, a man’s testosterone level naturally begins to decline at a rate of about 1-2% per year, making the term “pause” not entirely accurate.
Normal testosterone level, at any age, is measured in a range of 300 to 1,200 nanograms per deciliter. “Testosterone level is not a high-low scale,” explains Dr. Samadi. “If you’re at the low end of the range it does not mean you need more testosterone.”
Hormone replacement therapy for men is not new, but recent studies show there may be little effectiveness, and potentially more harm than good. In 2008, during the largest testosterone replacement study to date, researchers in the Netherlands found almost no improvement in quality of life, bone density, cognitive thinking, or muscle strength among those using testosterone.
There’s also a myth that increasing testosterone level decreases erectile dysfunction (ED). In truth, testosterone has more to do with sex drive and nothing to do with erections. What’s more, replacing a man’s testosterone level ceases his own natural production of the hormone, causing significant withdrawal symptoms when the replacement is stopped.
Prostate Cancer and Testosterone
“It’s important to be clear that male menopause does not cause prostate cancer, nor does low testosterone, but how men choose to manage those symptoms may impact their prostate cancer risk level,” explains Dr. Samadi.
Testosterone is widely accepted as a prostate cancer fuel, and is regularly countered through androgen deprivation therapy for prostate cancer.
Most recently, an Australia-based study of men in their 70s and 80s showed an increased risk of prostate cancer among men with higher testosterone levels, bothnaturally high and replacement high. Testosterone replacement therapy is not recommended for men at increased risk for developing prostate cancer.
Little is certain about the long-term effects of hormone replacement. “Work with your doctor to explore all of your physical, social, and lifestyle factors that you may be improperly attributing to low testosterone,” suggests Dr. Samadi. “Very few men have truly low testosterone levels and there may be many other remedies or changes worth exploring.”
Dr. David Samadi is Vice Chairman, Department of Urology and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York.
The Mount Sinai Medical Center Robotic Prostate Surgery Program