"Conventional means [of treatment] don't look at it as a pattern," Diamond says, who believes a more holistic approach is needed to address all of the symptoms of andropause. This could include conventional therapies combined with testosterone replacement therapy, psychotherapy, herbs, and diet and exercise.
Pros and Cons of Testosterone Replacement
Testosterone replacement therapy is the primary means of treating men with declining levels of testosterone, and this is still a controversial area. "What are the problems faced and can they be treated with testosterone? That's where the question lies," Dr. Dobs says.
"All men should be brought up to a certain level of testosterone," advocates Dobs, who suggests that minimum levels should be 300 nanograms per deciliter of total testosterone. The mean level for a 40-year-old is 500 nanograms, she says.
Instances where testosterone replacement therapy is advised, Dobs says, include men with clear bone density loss, which can lead to osteoporosis and decreased height, and in treating sexual dysfunction in cases where Viagra or other often prescribed remedies don't work. Another area of possible benefits of testosterone therapy may be in cases to maintain body composition and muscle — for instance, in patients fighting cancer.
But testosterone replacement therapy is "not a benign treatment," warns Dr. Michael A. Werner, a White Plains, N.Y., urologist with specialized training in male reproductive medicine and surgery and male erectile dysfunction.
Specialists say that men considering testosterone replacement therapy—whether by injection, patches, cream, gel or oral form—should get their PSA levels checked as testosterone replacement therapy could increase the risk of prostate cancer. (A PSA blood test identifies a man's risk for prostate cancer.) Other risks associated with hormone supplementation, particularly with injections, include the risk of stroke, an increase in liver toxicity and breast development. Ironically, testosterone supplementation also shuts down the production of sperm, Werner says.
Retired trucker Dorsey used to get testosterone shots monthly, but in the last year his doctor has prescribed a pill form, after Dorsey complained that the injections would make him feel uneven—great at first but three weeks after the shot, "I'd feel like crap." Although some doctors warn against oral medication, Dorsey says the treatments increase his energy level, and he generally feels better. His hormone and PSA levels are checked monthly.