Androgen replacement therapy

Androgen replacement therapy is a controversial hormone treatment for middle-aged and older men which is often intended to counter the natural effects of aging. Androgen replacement is also used in a non-controversial way for men who have lost their testicular function to disease, or cancer, or to other causes.

As men enter middle age they may notice changes caused by a relative decline in testosterone: fewer erections, fatigue, thinning skin, declining muscle mass and strength, more body fat. This dissatifaction with the changes of aging has led to the development of the idea of androgen replacement therapy. This treatment is based on a perceived need for artificial, external supply of androgens to be given, in order to supposedly restore the body and mind to a more youthful state.

Male hormones are called androgens from Greek words "anthropo" and "andro" meaning man, and "gen" meaning giving birth to. Primary among them is the natural hormone testosterone, which is produced in the testes and adrenals. Females also produce testosterone in the adrenals and as a precursor to estrogen, but the amount of circulating testosterone is generally far less than in males, although the ranges on the two genders overlap. Both sexes also produce an androgen precursor called dihydroepiandrostene (DHEAS) from which the body can make androgens. Androgens cause the secondary sex characteristics of males: facial hair, thicker skin, (aggressive drive), low body fat, deeper voice, muscularity, penis and scrotal growth and darkening, broad shoulders, body hair, erection of the penis, etc. With increasing age, testosterone production declines, and many of these changes start to reverse.

This "decline of maleness" with age has given rise to a term: "andropause". This term implies a parallel with menopause in women, although the two states are by no means equivalent. The term "manopause" has also been used in the popular press.

There are several artificial androgens, including nandrolone and various other manipulations of the testosterone molecule. Androgen replacement is via patch, tablet, pill or cream; or depot injections given into fat or muscle.

Users report an increased alertness and well-being, heightened libido and erection ability, increase in lean muscle mass and concomitant decrease in body fat.

Controversy

The controversy arises around several issues.

This treatment itself can be dangerous in a practical sense: androgens raise the blood pressure, thicken the blood, raise cholesterol and promote prostate cancer. Other side effects can include baldness, facial flushing, salt and water retention, and prostatic hyperplasia.

There is also the possibility of abuse: some athletes may demand far higher levels of androgen than normal in order to out-perform others, other people may feel they require greater doses in order to achieve what they perceive as a feeling of greater well-being.

The validity of the concept of maintaining older people at the hormone levels of a younger person is itself questionable. Also see Wiley Protocol.