While most men maintain normal testosterone levels during their lives, 70% to 80% of us with androgen deprivation (andropause, male menopause, testosterone deficiency syndrome [TDS]) experience hot flashes. Should we seek treatment?
Proponents for treatment tell us that low testosterone is associated with type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease. However, it isn't clear whether low testosterone causes these conditions. In fact, it might be the other way around. Accordingly, screening isn’t widespread. Most doctors are waiting for more evidence before prescribing testosterone replacement therapy.
The bottom line
Look beyond andropause. Yes, hot flashes might be part of andropause. On the other hand, they might result from HIV, AIDS, or tuberculosis. Hot flashes accompanied by pain in the testicles might indicate prostrate or testicular cancer or tumors in the pituitary or hypothalamus. Also, hot flashes might be triggered by monosodium glutamate (MSG), or as a side effect to drugs such as nifedipine (Adalat®, Procardia®, others), niacin (Niaspan®, Niacor®), and calcitonin.
Men, this isn't your wife’s hot flash. Consider seeing a physician if you experience intense warmth or flushing over the head and trunk accompanied by sweating and redness. Most common at night, flashes average four minutes, and often leave cold sweat behind. They may be infrequent or occur up to ten times a day. Some men also report anxiety, palpitations, or irritability.
More about the risks vs. benefits of testosterone replacement therapy are summarized below.
Benefits vs. Risks of Testosterone Replacement Therapy
Even in healthy men, by the age of 55 the amount of testosterone secreted into the bloodstream is much lower than it was just a decade earlier. In some men, these levels are low enough to trigger hot flashes.
For men considering testosterone replacement therapy, here’s an overview of the pros and cons.
Erectile function and libido
- Except perhaps in men with severe hormone deficiency, testosterone therapy is accompanied by a moderate to large improvement in libido, but only a small increase in satisfaction with erectile function
Health and well-being
- Administering testosterone to men with true testosterone deficiency improves their health and sense of well-being
- Most research suggests that low testosterone levels in men are associated with increased cholesterol levels and a higher risk of cardiovascular disease
- Yet, one study reported an association between testosterone gel application and the risk of cardiovascular side effects
- Testosterone treatment should be accompanied by monitoring the cardiovascular system
- Liver damage is associated with prolonged use of high dose methyl-testosterone
- Today, androgen replacement therapy uses testosterone, not methyl-testosterone, but is the potential risk worth the benefits?
- By age 50, many men have cells in their prostate that look like prostate cancer cells
- Some urologists are concerned that increasing testosterone levels might activate prostate cancer; but there’s no firm evidence that testosterone replacement therapy increases this risk
This list is not exhaustive. It’s clear however, that unlike other chronic conditions such as high blood pressure or cholesterol levels — where achieving predetermined test values define success — the measures of success with testosterone replacement are subjective. Similarly, while the risks associated with treating high blood pressure and cholesterol are reasonably well defined, the risks of testosterone replacement therapy are controversial.
Accordingly, we shouldn’t be surprised that the need to treat the symptoms of andropause — erectile dysfunction, night sweats, depression, fatigue, etc. — is debatable.
Confused? See your doctor.