Tuesday, January 19, 2010
Age Matters: Do men also need hormone therapy?
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi,
Last week I saw a TV show that said men go through the changes just like my wife did and that men need some kind of shot like my wife takes pills for her changes. They talked about menopause for men, and I know I got it.
Everything they talked about, I got it all, and I want the shots. I went to talk to my doctor about it, and he really didn't deal with it. He said that I can't turn back the clock and I shouldn't worry about it. But on TV they said you could.
Look, I'm 72 and I just want to feel better, and come on -- between the TV doctor and my doctor, somebody doesn't know what they're talking about around here. Do you give the shots?
-- Bedford
Over the years, I have seen the discussion surrounding male hormonal aging evolve to the point where there is general agreement of its existence but a lack of consensus as to the safe management of this normal aspect of the aging process.
As the term "menopause" is used to describe the decrease in female estrogen production, "andropause" is coming into vogue to describe the decrease in male testosterone (or androgen) production.
The current model of andropause usually begins between the ages of 40 and 60. Studies demonstrate that by approximately the age of 55, the amount of testosterone in the blood stream is up to one-third or more less than what it was in the previous decade of life. And by the age of 80 and older, the amount of testosterone has dropped to the point where it was before puberty.
The effect of this decrease in production is not only limited to a decrease in the sex drive but has far-reaching effects in male health involving decreasing strength in bone and muscle, lessening exercise tolerance, lethargy, sleep disturbances, irritability and cognitive decline.
To understand what might be happening to you, you must start with a complete evaluation by a health care provider who will consider other factors that may contribute to what you feel.
These include excessive alcohol use, smoking, obesity, high blood pressure, diabetes, prescription and over-the-counter medications, poor diet, a thorough sleep history, signs of depression and the amount of exercise you do.
Once these factors have been considered, the issue still revolves around the fact that andropause occurs as a normal part of aging and can cause or worsen many of the symptoms you feel. Just like in the female model, this is a condition where the natural decrease in the body's production of testosterone could be countered with medication to correct the imbalance. As logical as this seems, we have not reached the point where this can be achieved with uniform safety.
Before we discuss Testosterone Replacement Therapy, you should revisit the Tried and True Triad of common sense health: restful sleep, a lean diet and stimulating exercise -- all low-tech, boring and very cheap in comparison with the cost of the drug, the lab tests and the doctor visits. It is, however, very effective for helping you get to where you want to be. Even if you did TRT and did not include the Triad, you would not fully achieve your goals.
Now, the Triad is not easy, must be done by yourself and takes self-control, planning and discipline. But it works, and I'll say that it works better than TRT.
However, in answer to your question, TRT has been used under strict physician control and it should be noted that its management can be quite expensive with doctor visits every three to six months, involving comprehensive blood tests.
Some worrisome side effects have caused men I have seen using TRT to stop using it, making them psychologically worse off than when they started. The side effects are many and include problems involving prostate cancer, blood clots, liver toxicity and abnormalities of lipid metabolism.
In other words, be careful for what you ask for!
If you have questions for Dr. Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014 or e-mail them to extra@roanoke.com with "Age Matters" in the subject line.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging. His columns run monthly in Extra.
