Is testosterone in your future?

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It may roll back the wear and tear of aging

Imagine if there were a sure way to make you look and feel YOUNGER--and actual elixir that could give you more ENERGY and more muscle, and FLATTEN your BELLY to boot...

. . . AND LET'S SAY IT ALSO builds stronger bones, heightens your sense of well-being and gives you a more vibrant sex life. Sure, it sounds like some miracle pill hawked in the back of a supermarket tabloid. But the fact is, this wonder drug may exist And your body makes it

It's testosterone, that unbridled hormone that makes you a man, not a mouse. For most of your life you have a full tank, but as you age, the hormone slacks off. This changes isn't nearly as dramatic as the estrogen dive that women experience post-menopausally. Over time, though, your hormone levels can dip enough to where our energy, libido and even our thinking go downhill.

For women battling menopause, estrogen-replacement therapy is often the answer. And now it's being tapped for various age-related ailments above and beyond menopause--heart disease, osteoporosis, even Alzheimer's.

But what about men?

Well, promising new studies looking at testosterone's benefits in reducing aging's effects in men suggest that this hormone just might follow in estrogen's footsteps.

"With its potential benefits for bone, muscle strength, well-being and quality of life, testosterone supple-mentation for normal healthy older men might someday rival that of estrogen for women," says Adrian Dobs, M.D., associate professor of medicine and director of the endocrinology and metabolism clinical studies unit at Johns Hopkins University, Baltimore, where four testosterone studies are being conducted.

"It certainly has potential for reversing some of the effects of aging," says Rahmawati Sih, M.D., a geriatrics fellow at the St. Louis University Medical School. In her recent six-month study of testosterone's effect on age 50 and older with low hormone levels, she found that grip strength, balance, red-blood-cell count and memory all improved among the hormone takers, but not for those on placebo, or phony, shots.
HORMONAL POSSIBILITIES

That's one encouraging study--and there are more. But before we become high-powered hormone-rangers, let's look closer at what testosterone therapy can--and can't--do.

Building muscle What about the average guy who wants a little more muscle tone and strength? Should he take testosterone ? Muscle mass tends to decrease as we age, so why not?

Preliminary research points cautiously--though not conclusively--in that direction. In a recent study, for three months the hormone or a placebo was given to 13 healthy older men with testosterone levels below those of young men. Men on the hormone dramatically increased their lean body mass. In another preliminary study, a small group of men taking the hormone saw both muscle strength and the diameter of muscle fibers increase. "The potential to alter body composition, which truly helps men in terms of function, is really exciting," says Dr. Dobs. These studies were too small, though, to prove a benefit from testosterone.

It's known that hypogonadal men (those with severe hormone deficiency due to an underlying cause) do have trouble turning protein into muscle and thus have less muscle compared with normal men. Once given testosterone, they increase muscle mass and also lose belly fat. Young healthy men taking the hormone have also been shown to boost muscle protein synthesis as well their basal metabolic rate. "As for normal men, however, it's too soon to tell if supplementation may be warranted," says Dr. Dobs.

Protecting the ticker Because many more men than women get heart disease at a younger age, many experts laid the blame on testosterone. Other research, though, has shown that men who have heart attacks tend to have low testosterone levels.

"Our research suggests that testosterone may turn out to be protective," says Gerald B. Phillips, M.D., professor of medicine, Columbia University College of Physicians and Surgeons, New York City. In a new study, he compared testosterone levels of 55 men and found, for the first time, that lower hormone levels accompanied higher degrees of heart disease (in terms of coronary clogging). He also found a positive link between testosterone levels and HDL cholesterol (the good kind). This suggests "the hormone may help protect the heart by raising the HDL cholesterol level," says Dr. Phillips (Arteriosclerosis and Thrombosis, May 1994).

Although this is a first-time observation, other research has shown that extra testosterone may raise HDL levels and lower LDL(the bad stuff). "As estrogen may prevent heart attacks in women, testosterone may do the same for men," says Dr. Phillips.

Banishing the belly Belly fat and low testosterone levels tend to go hand in hand. But once those hormone levels are brought up, the weight in that spot may tend to slough off. In a Swedish study of 23 men, those taking testosterone saw their belly fat decrease, despite the fact that their total fat didn't. "And that redistribution may decrease heart-risk factors," says Dr. Phillips. If belly fat is indeed linked to heart disease, slimming the stomach via testosterone supplementation might help prevent serious disease (International Journal of Obesity, December 1992).

Lowering insulin In that same study, insulin sensitivity--another heart-disease risk factor tied to abdominal fat--improved after testosterone therapy. "In my studies, I've found a strong correlation between testosterone and insulin levels; that is, the higher the testosterone, the lower the insulin--with such levels being good. But a correlation by itself does not establish a cause-and-effect relationship," says Dr. Phillips. "In the Swedish study, though, insulin sensitivity got better (as did cholesterol and blood pressure), which suggests testosterone may be responsible."

Bolstering bones Fracture risk in men can double every five years after age 50. Research shows hypogonadic men have a higher risk of fractures compared with normal men. In one study, for example, 59 percent of men with hip fractures had very low testosterone levels, compared with 18 percent of the control group of men without fractures. "The bone loss that comes with aging may be due to the accompanying drop in testosterone levels," says endocrinologist Peter Snyder, M.D., a professor of medicine at the University of Pennsylvania, Philadelphia. Bone-density improvements have been seen in men with hypogonadism and associated osteoporosis after taking the hormone. Dr. Snyder is now leading a study in which testosterone levels of normal men over 65 will be upped to those of normal men age 20 to 40." We're looking at bone calcium (a measure of bone strength) as well as muscle strength," he says.

Sparking sex drive Most problems in bed aren't testosterone's fault. But well-controlled research has shown that hormone therapy can boost sexual desire in younger men with low testosterone levels. Whether the hormone can provide an extra sexual edge for men on a mild hormonal siesta remains to be seen, although there have been reports that libido does rev up during therapy. "Some men in our study didn't feel a change at all, but their wives say that they could tell the difference," says Dr. Sih, referring to boosts in sex drive and mood.

Boosting the brain "Research has shown that changes in cognitive abilities may coincide with seasonal changes in testosterone levels," says Jason Brandt, Ph.D., associate professor of psychiatry at Johns Hopkins University School of Medicine, Baltimore. And when those levels change, so may your ability to find your way around a new town. In men, research has shown links between very low (and extremely high) testosterone levels and poor "visuospatial" ability--one of the skills needed to read a map. Another study reported earlier in Prevention found that normal men ages 60 to 75 receiving hormonal therapy boosted their ability to work with three dimensional objects.

"Testosterone may be why men do better than women in tests like this," says Dr. Brandt.

Massaging your mood Testosterone's no Prozac, but many men in these studies report improvements in mood. "We tend to find that their feelings of well-being go up," says Dr. Dobs.

"People have said they feel better about themselves when they take the hormone," adds Dr. Sih. "I don't see the hormone used as a feel-good thing, although you never know what may happen," says Dr. Sih.
THE DOWNSIDE

Of course, testosterone therapy does have side effects. If red blood cells get too high--a potential result from hormone treatments--you may up your risk for a stroke. "Testosterone may also reduce our ability to make our own hormones, resulting in lifetime dependency," says Kenneth Goldberg, M.D., founder and director of the Male Health Center, Dallas, and author of How Men Can Live As Long As Women (The Summit Group).

Plus, testosterone can make prostate cells grow faster, aggravating problems like benign prostatic hyperplasia. And if a small cancer is present, it's not known if extra testosterone will make it worse. Prostate-specific antigen (PSA) levels (a substance measured for prostate cancer), though, may rise with hormone therapy. "If you're taking testosterone, you must monitor PSA levels and have digital rectal exams done regularly," says Dr. Sih.
ON THE HORMONE FRONTIER

Right now, testosterone is used only for treating hypogonadal men. What if you don't have that kind of deficiency but feel you could use an extra hormonal kick?

If you're feeling low in energy or libido, talk to your doctor. Your problem may be hormonal--or something else entirely. Inactivity, bad nutrition, excessive alcohol and cigarette use as well as use of medications may be more to blame.

And most of these variables can be fixed through exercise and a proper diet. "First we need to deal with the whole man, then perhaps his hormone levels," says Dr. Goldberg. "A man might need some extra testosterone, but only as a part of an overall approach to improving his health." So until more research is done on testosterone supplementation on normal men, settle on lifting weights, hitting the treadmill and reducing the fat in our diets to keep feeling young. Hormones or no hormones, you know that works.

ILLUSTRATION

TAKE-OUT TESTOSTERONE

Until recently, testosterone was given orally or by injection, which didn't always offer a consistent dose over time. That's changed, however, with transdermal delivery (a.k.a., a skin patch), which continuously pumps in the hormone where it's absorbed and taken directly into the blood. The preparation that is currently FDA approved can be placed only on the scrotum, but Adrian Dobs, M.D., associate professor of medicine and director of the endocrinology and metabolism clinical studies unit at Johns Hopkins University, Baltimore, is testing a more convenient patch that's usable on other body parts.

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