Can a New Gel Help Older Man More Vital?

What Is AndroGel?
Who Will It Benefit?
How Does Testosterone Therapy Work?
Is There A Downside?

Topical testosterone may be tempting, but experts say it probably won't help.

Robert Poltz is a man's man. Although he's in his 50s, he has the body of a much younger man.

But that's not enough for Poltz, who is hoping to find the Fountain of Youth in a new testosterone replacement gel — AndroGel — which hit pharmacies in June.

His goals are anything but modest. He wants to reduce his body fat to 5 percent or less so he can "look like those guys that model in all the muscle magazines." He hopes to recover lost hair, lose the gray and reduce wrinkles. And most of all, he says, "I want super virility, similar to what I had in my 20s."

Poltz is among a growing number of men who hope to stave off or reverse aging by boosting their levels of the male hormone testosterone. After all, he says, "Women are discovering the benefits of estrogen replacement therapy. Why shouldn't I do likewise with testosterone?"

What Is AndroGel?
AndroGel is a clear gel that is rubbed into the shoulders, upper arms or abdomen every day to maintain more even levels of testosterone in the body. It's available only by prescription, and men who take it must be evaluated and monitored by a doctor.

AndroGel has caught the attention of men like Poltz because it is easier to use than previous testosterone medications. Until AndroGel hit the market, men needing a testosterone boost had to give themselves injections or wear a patch on their skin. Injections can't mimic the body's fine control of the hormone, so men often experience emotional and physical ups and downs, including irritability right after the injection and fatigue as it wears off. The patches maintain testosterone at a more even level but can cause skin irritation and may fall off in hot weather.

Popular magazines have been predicting that AndroGel will become the next Viagra, sought out by aging baby boomers reluctant to give in to the effects of aging, and will become more popular among younger men who want to bulk up at the gym or pump up their sexual prowess.

After all, health stores and Web sites aimed at bodybuilders do a brisk business in supplements that claim to raise testosterone levels, despite indications that it is dangerous and does little good for men with normal levels. And doctors say older men already ask for testosterone, usually if they feel their sexual interest or performance has dropped.

Who Will Benefit?
Testosterone is the stuff that makes a man a man. A surge of testosterone in the womb causes the male sex organs to develop. In adolescence, testosterone surges again. It deepens male voices, enlarges muscles, causes facial and body hair growth and gives men their sex drive. The normal range is from 300 to 800 nanograms of testosterone per deciliter of blood, but in teen-age boys, it can jump as high as 1,000 nanograms.

Dr. Adrian S. Dobs, an associate professor of endocrinology at the Johns Hopkins School of Medicine, says testosterone is a medical treatment for some men who have abnormally low levels of the hormone because of the aging process, chronic disease or exposure to alcohol or chemicals. Symptoms of low testosterone include fatigue, decreased sex drive, depression and low energy. Between 4 million to 5 million men have this medical condition, according to Unimed Pharmaceuticals, the company that makes AndroGel. Dr. Dobs says that about 25 percent of men go through andropause, the male version of menopause, in which levels of testosterone drop significantly with age. In many men, testosterone levels don't change much with age.

For those men who do need testosterone, AndroGel is an excellent alternative to present options.

Unfortunately, testosterone medication is not indicated for a man with testosterone levels in the normal range because taking testosterone will only stop the body from making its own. "If you have normal levels and you take it, it's just going to suppress your own body from making testosterone," Dr. Dobs says.

Doctors do worry that AndroGel will be sought out by otherwise healthy men seeking instant youth and manliness who are unaware of the potentially dangerous side effects. "It is a controlled substance, so I'm very concerned about the rampant use of it without a prescription," says Dr. Dobs.

How Does Testosterone Therapy Work?
In popular imagery, testosterone is inextricably linked with machismo. Men with pumped-up muscles and a vigorous sex drive are thought to have more of the stuff. And men who find their sex drive and energy waning as they age are thought to be testosterone-deficient.

It isn't that simple. Even for men experiencing fatigue, a lowered sex drive, depression and other uncomfortable symptoms, ferreting out the cause isn't as easy as measuring the level of testosterone in the blood.

For one thing, men vary in the way they process testosterone. So someone with a seemingly low level could be getting as much as he needs, whereas someone with a higher level could be having trouble using the hormone his body produces.

To complicate matters, Dr. Dobs says complex behaviors and symptoms like sex drive and depression rarely is caused solely by chemical imbalances, but usually stems from a range of factors, including social environment. Likewise, aging men are experiencing a number of physical changes that could contribute to the symptoms they are experiencing as much as dropping levels of testosterone.

Is There A Downside?
Men may be tempted to give supplemental testosterone a try. But taking this drug also can cause significant, and sometimes dangerous, side effects.

It can boost muscle mass, but it also can cause make pectoral (chest) muscles to expand into breasts. Young men tempted by hopes of pumping up should know that testosterone treatments also can stop bone growth and result in short stature.

Testosterone may reduce the good cholesterol HDL, but there is no data to say it will cause heart disease, and testosterone has been linked with liver problems. (For the record, no liver problems have been associated with AndroGel in men without pre-existing liver disorders.) All forms of testosterone can decrease fertility.

The biggest concern has been a possible link with prostate cancer. Research has shown that testosterone medication doesn't appear to cause prostate cancer, but it can encourage faster growth of prostate cancer once it forms.

One unusual, side effect is that testosterone can be transferred to another person during "vigorous skin-to-skin contact." However, in most situations this is not a problem.

Still, in our quick-fix society laden with sexual images, none of this is likely to deter men who suspect a simple gel may be able to bring back what they have lost or give them more of what they don't have.

As Poltz says, "It's time to take an aggressive posture toward men's health, and I've always been a risk taker. If there were serious concerns (about AndroGel), would the ultraconservative Food and Drug Administration have approved the product?"

Last updated August 30, 2000