Experts disagree on treatment for so-called 'male menopause'

As men approach middle age, they tend to wane sexually, gain weight, lose muscle mass and have less energy. To fight this decline, many American men are turning to hormone therapy to replace testosterone, which also fades over time.

But experts can't even agree on what to call the male age-related condition, never mind how to treat it or what the treatment risks might be.

What they can agree on, however, is that men need to be careful about the hormone-replacement therapy.

"Although some people talk about 'male menopause,' obviously men don't have menopause. It's a misnomer," Dr. Glenn Cunningham, a spokesman for the Endocrine Society and a professor at Baylor College of Medicine in Houston , told HealthDay .

"In women, menopause is relatively abrupt, and it occurs at a standard age," Cunningham said. "But in men the decline is gradual, takes place over decades and isn't complete -- it's usually only a partial loss of hormone."

Dr. Shalender Bhasin, chief of the division of endocrinology at Charles R. Drew University in Los Angeles and a professor of medicine at UCLA School of Medicine, told HealthDay that there's "no question that testosterone levels decline with advancing age."

But, Bhasin asked, "are the [physical] declines seen in older men related to declining testosterone levels? On that point, there's no agreement."

Researchers have conducted small trials of testosterone replacement, with some men showing improvement, but "none of these studies was large enough to show clear-cut benefits on the health of older men," Bhasin said.

And the risks associated with using the powerful hormone testosterone over time are as unclear as the benefits.

"The two major areas of controversy are whether giving testosterone therapy to older men will increase their risk of prostate disease, including cancer, and whether it will increase or decrease their risk for heart disease," Bhasin said. "There's no evidence right now in either direction."

Cunningham said that testosterone declines vary, and that hormone replacement therapy isn't for everyone.

"I think only those men who are testosterone-deficient should be considered for replacement therapy," he said. "And if men who are 40 or 50 choose to be on treatment, they should be followed carefully."

But many men looking for help in fighting the effects of aging are not waiting for clinical trials and definitive answers.

"Testosterone sales have been growing exponentially," Bhasin said. "In each of the past four years, sales have doubled," until they've exceeded a half-billion dollars a year, he said.

This enormous demand shows that there is a real need among older men, he said.

"People are living longer, and older men and women are interested in having a better quality of life," Bhasin said. "And that's not unreasonable."

But it also seems that experts will not reach agreement on the use of testosterone anytime soon.