Men who want everything (even the menopause)

Powerful interests are keen to sell the idea that male testosterone levels have to be kept very high

It never really made sense, did it, all that stuff about the male menopause as an explanation as to why men over 40 so often decided to recapture their youth with a flashy car, some spray-on hair or a girlfriend young enough to be their daughter? It always seemed that the real reason for such behaviour was just sheer panic about the prospect of growing older.

It never really made sense, did it, all that stuff about the male menopause as an explanation as to why men over 40 so often decided to recapture their youth with a flashy car, some spray-on hair or a girlfriend young enough to be their daughter? It always seemed that the real reason for such behaviour was just sheer panic about the prospect of growing older.

After all, if the male menopause, or andropause as its enthusiasts like to call it, really was all it's cracked up to be, men wouldn't have the energy suddenly to start gadding about like people half their ages and waistlines. Instead, they'd be all too happy to sink into an armchair and gratefully accept that the missus, with her HRT patch slapped proudly on her buttock, could handle mowing the lawn herself.

And now a study of 1,700 men, the largest so far, confirms these suspicions. Professor John McKinlay, of the New England Research Institute, reckons that the symptoms of a condition diagnosed since the 1930s as the andropause are just normal signs of ageing, and little to do with any hormone deficiency.

Men who suffer a drop in testosterone and feel tired and lacking in energy, would be better off changing their diet, shedding some pounds and exercising more, rather than running to the doctor for a quick fix. "We are," says Professor McKinlay, "medicalising lifestyle problems and the natural process of ageing." Thought so.

So why is it then that so many men - already a quarter of a million in the US - seem so keen to be medicalised? There is a me-too element in male efforts to grab a little of the menopausal action. Dr Malcolm Carruthers, a leading medical advocate of the male menopause and the chairman of the British Andropause Society, puts this clearly when he airily declaims on the society's website that "what's hormonal sauce for the goose should be hormonal sauce for the gander".

What a funny attitude this is. As Professor McKinlay is at pains to explain, the female menopause is the result of an actual and extreme change in biological function, while there is no such change in male reproductive abilities. Testosterone levels do decline, but only in tiny increments. Men can have children until they die of old age. Women can't. If what Dr Carruthers wants is equality, he might just as well argue for all men to have the snip before they're 55. As quick fixes go though, this doesn't have quite the appeal of testosterone therapy.

Nor, of course, does it have the same potential for profit. In the US, where testosterone therapy has really taken off thanks to AndroGel, which delivers testosterone easily as a colourless gel that is rubbed on the shoulders, the company that makes the drug has a uniform presence behind the scenes of this medical revolution.

Not long ago, as Dr Jerome Groopman reported for The New Yorker, a public awareness campaign was launched to warn men that they may be suffering the andropause, while a similar campaign was directed at medical professionals. Both campaigns were funded by Unimed, a division of the Belgian conglomerate Solvay and the makers of AndroGel.

Meanwhile, in Boston, one concerned doctor placed ads locally, asking men with "low sex drive" or "low energy" to have their testosterone tested at his clinic. The ads and the tests were both underwritten by Unimed, which also provided a questionnaire for worried men to fill out.

Sincere, no doubt, in their belief in the andropause and excited by the idea that they can intervene positively in the lives of middle-aged men, many doctors take comfort in the findings of the First Annual Andropause Consensus Conference, held in April 2000. It recommended that all men over 50 be screened for testosterone deficiency and suggested that therapy might benefit those found wanting.

The conference, which convened six weeks before Androgel came on the market, was wholly funded by Unimed, while nine of the 13 panelists at the conference had financial ties to the company. There's no doubt that there are powerful interests keen to sell the idea that male testosterone levels have to be kept very high, all the time.

But artificial doses of testosterone have other advocates too, most notably Andrew Sullivan, the prominent gay, right-wing journalist. He was prescribed testosterone injections in 2000 as part of treatment for HIV. Immediately won over, Mr Sullivan has been proselytising what he calls "the he-hormone" ever since.

"My appetite in every sense of that word expanded beyond measure," Mr Sullivan wrote in a 7,000-word New York Times eulogy to testosterone. "Going from napping two hours a day, I now rarely sleep in the daytime and have enough energy for daily workouts and a hefty work schedule. I can squat more than 400 pounds. Depression... is now a distant memory. I feel better able to recover from life's curveballs, more persistent, more alive. These are the long-term effects. They are almost as striking as the short-term ones."

Mr Sullivan goes on to describe the short-term effects. He talks of his quickened wit and more impulsive judgement, the creeping up of a feeling of lust ("You are not helpless in front of it, but you are certainly not fully in control"), and his inability, shortly after his fortnightly injections, to control anger and aggression ("I vowed to inject my testosterone at night in future.")

For women who already feel some fear of such "manly virtues" - and what women cannot feel a little trepidation in a week that confirms that while crime is falling overall, rape is on an upward gallop - the idea of testosterone therapy for men becomes scary rather than benign.

Mr Sullivan suggests that a more equal society could be attained if women started taking testosterone, too. My own suggestion would be that this is by no means a good idea. Perhaps male testosterone gently declines in line with a man's physical ability to defend himself in a fight, or take part in sexual intercourse. Maybe it really would be much better for men with declining testosterone to take Professor McKinley's advice and look after themselves better.

Those still beguiled by the prospect of an effortless return to their younger vigour might like to consider the price: testosterone can trigger abnormal enlargement of the breasts and shrinking of the testicles (as natural production decreases); it raises the level of circulating red blood cells, making the blood viscous and the body more vulnerable to heart failure or stroke; it also accelerates the growth of prostate cancer. Indeed, it is only now becoming clear that oestrogen replacement therapy, hailed in the 1960s as a panacea for menopausal women, increases the risk of breast cancer, strokes, heart attacks and blood clots.

We are part of a generation that expects to stay younger much longer. We expect, in middle age, to trot off to Glastonbury, bring up families and keep up with fashion.

At the same time, despite the much telegraphed example of our trim and attractive celebrity "role models", we are getting fatter and more sedentary in our lifestyles by the day. This is more likely to be causing declining testosterone in middle-aged men than any hormonal syndrome. The risks of reaching for a hormonal solution seem quite large. It would be a pity if medical interventions to stave off ageing ended in us dying younger instead of living longer.

d.orr@independent.co.uk