Running on empty

The big fear has long been that TRT may be linked to prostate cancer, but so far there’s been little evidence of that, although long-term studies have yet to be done. It’s well known that testosterone may feed an existing cancer but no proof that it creates cancer in a man who is cancer-free. Dr. David Saul, a Toronto GP with a special interest in men’s sexual health, recently published the results of his study of 42 men aged 60 to 79, all taking TRT for two to six years.

“Only one man developed prostate cancer,” he says, “but so did his two brothers who weren’t on TRT.” Saul’s latest study found that among impotent men over 65 who had been considered “Viagra failures,” most had sexual success after starting TRT and then trying Viagra again.

It used to be thought that hormonal decline for both men and women was natural; the only difference was women got hot flashes and men got hot Porsches. Then, when the term “andropause” was coined, drug companies were accused of trying to medicalize a natural event by putting the “men” in menopause. But the new thinking is that andropause is not the male equivalent of menopause. While meno- pause affects all women eventually, andropause affects only some men.

In normal males, testosterone rises sharply at puberty and is responsible for masculine features such as bigger muscles, deeper voice, facial and body hair and sexual maturity. Around age 40, testosterone production drops off slowly at a rate of about one per cent per year.

Many men don’t notice any difference at all, just as they don’t notice a difference in their car’s performance if the gas tank is full or half-full. For some men, however, the T level drops off too quickly, and they’ll simply run out of gas. For others who may not have had a full tank to begin with (whether from genetics or from damage such as inflammation of the testes, bike trauma or an undescended testicle), even a gradual reduction will mean that eventually they’ll be running on empty.

Testing and treatment If low-T is suspected, the doctor orders a blood test to check testosterone levels. The most accurate test is done in the morning on two separate occasions and looks not only at total testosterone but also at bioavailable T. As men age, a substance called sex hormone binding globule can climb steeply, binding much of their testosterone and making it unavailable. So while a man’s totals may be normal, their bioavailable T may be low enough to cause symptoms. (This test, not covered by most provincial health plans, costs about $50.)

The second part of the diagnosis consists of the ADAM (Androgen Deficiency in Aging Men) test. It asks, “Do you lack energy?” “Have you noticed yourself enjoying life less?” and eight other questions. While positive answers could indicate various conditions such as thyroid disease, diabetes or depression, the blood test helps to confirm the diagnosis. (To view the full test, go online to