Running on empty

Low testosterone can affect the quality of a man’s life. Here’s what to look for and how to treat it.

Richard Hébert used to be a grumpy old man. “For years, I was bad-tempered, not interested in anything, burned out and had no energy,” says the 61-year-old retired entrepreneur from Montreal. While everyone around him seemed to be running on a 24-volt battery, Hébert felt he was struggling along on a double-A.

When Hébert heard a local endocrinologist on television describe similar symptoms caused by low testosterone, he immediately contacted the doctor he had seen on the program and, after undergoing tests, started testosterone replacement therapy (TRT). It took several months, but eventually he began feeling more energetic, content and confident than he’d felt in years – or possibly ever.

“I can climb up and down the mountain with my grandchildren, which I couldn’t even do with my own children,” says Hébert, who has been on testosterone replacement therapy for five years. “I look at life with a smile now.”

Diagnosing testosterone trouble

Hébert is a classic case of a man with the medical condition of low testosterone, also called low-T, hypogonadism or, in men of middle age and older, andropause. Symptoms can include bad mood, irritability, lethargy, decreased vigour, difficulties with short-term memory, reduced interest in sex, sleep problems and a tendency to conk out in front of the TV after dinner. So far, this sounds like nothing more than geezer-itis. But since testosterone affects every body system from the brain to the bones, andropause may also come with significant physical problems: wasting muscles; reduced height from osteoporosis; heavy sweating at night (Hébert says his chaleurs were so bad he’d have to change the sheets twice nightly); and reduced erectile function (see “Is It Low-T or ED?” below).

Based on U.S. figures, it’s estimated that in Canada between 200,000 and one million men may have testosterone insufficiency, but only a small percentage know it. What brings low-T men to the doctor is not sexual problems but fatigue.

“The main complaint is lack of energy,” says Dr. Jean Mailhot, the endocrinologist whom Hébert saw on television. “Physically, psychologically, emotionally, intellectually – they just want to rest.” Mailhot is head of an andropause clinic in Laval, Que., which has more than 500 male patients on TRT, most over 50.

While low testosterone remains underdiagnosed, the popularity of TRT is growing rapidly. In 2007, Canadian pharmacies filled more than 330,000 prescriptions for testosterone. Interest in low-T is rising due to the marketing of new testosterone delivery systems, such as an easy-to-apply gel, the desire of baby boomers to stay perpetually young and vigorous and an increased awareness of the benefits and drawbacks of hormone replacement therapy in general.

Is TRT safe?

Like HRT for women, TRT remains controversial, although increasingly doctors agree that in most cases it’s very safe – at least for the short term of up to three years.

“I was a late convert to the idea of using testosterone,” says Dr. John Collins, an urologist and head of the andrology clinic at the Ottawa Hospital. “There’s no doubt we can improve the quality of life in men who are properly selected and monitored. But are there going to be long-term deleterious side effects? Nobody knows the answer.”