Originally created 06/02/01

Hormone replacement: Not for women only

Older men and their partners should know about ADAM, a simple questionnaire to help identify individuals who may benefit from the male version of hormone-replacement therapy (HRT).

Such replacement therapy with the female sex hormone, estrogen, has been a health boon for millions of women who have gone through menopause. They take pills or apply medicated "patches" to the skin to replace estrogen no longer produced naturally in the body. Evidence suggests that it helps protect women from osteoporosis, heart disease and perhaps other health problems.

Male HRT involves replacing the sex hormone testosterone. Natural body production of testosterone starts to decrease around age 40, and usually drops by about one per cent per year. The decline is gradual, and men have no clear-cut milestone like the female halt in menstruation at menopause to mark their transition to "andropause."

Andropause is male menopause, named because testosterone also is known as androgen. Andropause means a decline in androgen or testosterone production.

Male HRT is getting more attention these days thanks to the appearance of new forms of testosterone that don't require injections. They include testosterone skin patches, and the new rub-on-the-skin testosterone medicine, AndroGel, which hit the market in 2000.

Studies suggest that male HRT may have many benefits. These include increased bone and muscle strength, a reduced risk of heart attacks, an improved psychological sense of well-being, more energy, and better sexual function.

Researchers estimate that about 30 per cent of men in their 50s have testosterone levels low enough to cause andropause symptoms. The proportion increases steadily with age, with about 70 per cent of men affect by age 70. Experts believe that 4 million men have low blood testosterone levels.

Millions more may have borderline testosterone levels that decrease the quality of life. But only about 500,000 are getting treatment.

A blood testosterone test is the obvious way of checking to see if a male is going through andropause (or has low testosterone levels because of other health problems). Using the blood test on all middle-aged men, however, would be too expensive.

That's why the ADAM (Androgen Deficiency in Aging Males) questionnaire, developed by Dr. John E. Morley, may be helpful. Dr. Morley is director of geriatric medicine at St. Louis University school of medicine and a pioneer in research on andropause.

The ADAM questionnaire can be used as a screening tool to help men, and their partners, decide whether to visit the doctor and ask about testosterone gel or other treatment. Doctors also use ADAM to help decide which patients should get a testosterone blood test.

Here is the questionnaire:

1.) Do you have a decrease in libido (sex drive)?

2.) Do you have a lack of energy?

3.) Do you have a decrease in strength and/or endurance?

4.) Have you lost height?

5.) Have you noticed a decreased enjoyment of life?

6.) Are you sad and/or grumpy?

7.) Are your erections less strong?

8.) Have you noticed a recent deterioration in your ability to play sports?

9.) Are you falling asleep after dinner?

10.) Has there been a recent deterioration in your work performance?

Men who answer "yes" to questions 1 or 7, or to a total of any three questions may have andropause symptoms that can be treated with testosterone replacement.

Discuss it with your doctor, because other medical problems can produce similar symptoms. Those include clinical depression, blockages in blood vessels that supply the penis, and medication side effects.

HRT with testosterone won't help men with such problems, but other treatments for these conditions are available.


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