December 27, 2006

Hormone Replacement for Men

My husband seems to be tired and forgetful, and has a much lower sex drive than he used to. Is there such a thing as hormone replacement for men?

You raise an interesting question. Hormone replacement in women is still a very controversial topic, with the pros and cons vigorously debated. The situation is much the same for men.

Males slowly decrease testosterone production. Once over the age of 50 their levels drop around 10 percent, and continue to decrease slowly as they age.

Actually, men in whom low levels of testosterone are found—i.e., less than 300 µg./100 mls. of blood—may receive some benefits from testosterone treatment. Some men with low testosterone levels have increased fatigue, loss of sex drive, a degree of impotence, muscle weakness, and forgetfulness. But these symptoms may also be indicative of aging.

Some have reported lower levels of testosterone in Alzheimer’s disease, but treatment with testosterone has not made significant differences. The possibility of increased heart disease—because testosterone lowers good HDL cholesterol—has been raised.

Just as estrogen is usually not given to women with reproductive tract cancer, testosterone is usually not given to men with prostate cancer—even when the cancer has been treated. There is no evidence testosterone causes prostate cancer, but why give something that could help prostate cancer grow?

There is evidence that a man who has unusually low testosterone levels (less than 300 µg./dl.) may benefit from symptom relief if he has:

• Decreased sex drive

• Forgetfulness

• Depression

• Short attention span

• Muscle loss, or

• Osteoporosis.

However, such a treatment would require the careful monitoring of prostatic function.

Testosterone is not available as a tablet. Usually, an injection is required every two weeks. Some men prefer a testosterone patch; others a gel to rub on their skin.

Unless a man has demonstrably low testosterone levels, we do not think “replacement” is indicated. The risks are as yet not known, so a person using replacement becomes somewhat of an experimental model.

Your question may indicate some dissatisfaction with your sex life.

There is more sexuality above the waist than below it. The making of time for intimacy is a very important part of marriage.

A discrete discussion among the two of you and your doctor may help. These matters should not cause either of you embarrassment when discussed confidentially with a trusted physician.

For those on aspirin and coumadin as blood thinners, would drinking copious amounts of water be a better option? Researchers at Loma Linda showed that drinking water rather than juices and the other beverages significantly reduced the risk of coronary heart disease.

We can tell you have an inquiring mind. Indeed, Dr. Chan at Loma Linda did show that those who drank water preferentially over other beverages had fewer heart attacks. The nature of this association, even if a causative one, was not clarified. The word “copious” is also something that is not easily quantified. There are dangers in recommending a “copious” intake of even water, as there is a condition of water intoxication.

Seldom are people advised to take aspirin and coumadin, since the former makes the regulation of the dosage of the latter more difficult.

Low-dose aspirin, in a dose of 81 milligrams per day, has been shown to reduce the risk of heart attack in at-risk populations (see NEJM, December 1, 2005, 353: 22). The level of confidence in this action of low-dose aspirin is very high, with high numbers of patients having been studied. In fact, this benefit is evidenced by multiple studies that have repeatedly shown benefit.

A person with chronic atrial fibrillation has a sizeable risk of suffering a stroke. This risk is approximately a 1-in-10 chance each year the person lives. Anticoagulation with coumadin lowers this risk and, once again, the evidence is of high level.

There is no reason to doubt the Loma Linda study, but it was not a prospective study. It looked back at data collected in the course of earlier studies. It certainly raised interesting questions, but before making any recommendations about substituting one treatment for another, prospective and comparative studies need to be made.

We see no reason for people who are taking either aspirin or anticoagulants, on their physicians’ advice, not to take liberal amounts of water. But this is an additional measure, not a substitution.

Preventive and therapeutic activities are not the same. We often confuse the two, believing that what prevents must cure; this is not always the case. This does not mean we do not need the preventive lifestyle elements, but sometimes a cure will require a more specific action.

My prison’s water comes from the city’s water system. The city uses “recycled water from urine and feces and showers and cleaning detergents, etc.” What dangers are there to the human body from drinking recycled water, with all the chemicals being used to make it drinkable?

All water is recycled. Over the millennia, water has gone from the oceans to the clouds, to rain, and then filtered through the earth and back to the ocean. Such water dissolves many chemicals in the course of its recycling, including some from human and animal waste. That is why the oceans are so salty. So, natural water supplies may have elements in proportion greater than your city water supplies. Most city water is filtered to remove larger solids; then a flocculation process precipitates smaller solids. Processes of precipitating out high concentrations of individual elements may be employed to further process the water.

Toxic elements such as mercury or lead are seriously monitored. Bacteria are killed by treatment, usually with chlorine in dosages that have been shown to be nontoxic. Some municipalities have added one part per million of fluorine to reduce the risk of dental caries. The water available in most North American city water supplies is meeting standards of safety that are unparalleled in the history of mankind.

Nevertheless, a major industry has sprung up around bottled water. Some of the largest bottlers of water in the world (e.g., Coca Cola) use municipal water supplies as their source. In Africa I once purchased a bottle of water that was sealed. To my amazement, after a couple of weeks, I noted algae growing in it! Some folk advocate pure, distilled water, and are eager to sell a distilling apparatus. The water so obtained is pure water, but may be a poor choice, especially for those whose city water may provide a valuable quantity of minerals such as calcium. Some people, such as the wife of one of the two writers, insist on a charcoal filter to improve the water’s taste. Yet the water is safe straight from the tap.

We who live in countries sufficiently advanced to have recycled and treated water should consider ourselves fortunate compared to the 80 percent of the world’s population who struggle with dangerously polluted and unclean water supplies.

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Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA executive director and associate director of Health Ministries.

Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland, 20904. Or you may send your questions via e-mail to [email protected] . While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.

Hormone Replacement for Men

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