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HRT—Hormone Replacement Therapy For MEN

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Andropause—Otherwise Known as “Male Menopause”

Just as women go through important hormonal changes in midlife, male hormone levels begin to drop over time as well.  In fact, men’s testosterone levels peak at age 17 and begin to decline about 1 percent every year starting at age 30.  By the time a man reaches age 80, his testosterone levels will have fallen to about half that of a younger male.

Testosterone Availability

In all actuality, only about one-half of a man’s testosterone is active biologically, at any given time as well.  The other half is bound to the sex hormone-binding globulin that transports sex hormones, making it unavailable to the body for activity.  This means that while testosterone may be produced, it is not actually viable for growth, sexual function, reproduction, or the building of muscle mass.

Physical and Hormonal Changes

When a man reaches middle age a process known as, Aromatase begins to take place in the body, causing more and more testosterone to begin to convert to estrogen.  Men also experience an increase in elevation of the sex hormone-binding globulin.  Together, these changes result in a net increase in the ratio of estrogen to testosterone and a decrease in total and free testosterone levels.

Male Testosterone—Who Needs It—And When?

Male fetus

Just seven weeks after conception, a male fetus begins to produce testosterone.  This works to develop the male reproductive system, as well as masculinize the male brain.

Teenage adolescent testosterone hormone levels surge causing changes including:

  • Lower voice
  • Broadening of shoulders
  • Facial and pubic hair growth
  • Masculine facial features/jaw
  • Increased sex drive
  • Muscles that begin to fill out
  • Increase energy
  • Links to behavior including aggression/competitiveness

In adult men testosterone helps maintain:

  • Strength and muscle mass
  • The distribution of fat
  • Bone strength
  • The production of red blood cells
  • The libido
  • The production of sperm

In younger men,

  • Levels of testosterone tend to fluctuate a great deal and are elevated early in the morning

In older men,

  • The liver and fat tissue converts some testosterone into estrogen (as they age).
  • Levels of testosterone are more consistent and even so it is easier to get a more accurate reading.

Male Hormone Replacement Therapy—Benefits Beyond Increased Sexual Function

Many men are concerned about the possible need for hormone replacement therapy as they age.  Because the hormone, testosterone is necessary for sexual function, bone density, healthy red blood cell levels and muscle bulk, many men struggle with natural declining levels produced in the testicles.

The benefits of testosterone replacement therapy can renew free levels (of testosterone) to stimulate sexual interest once again, and help with erectile dysfunction.  By raising testosterone, health issues such as diabetes, obesity, metabolic syndrome and osteoporosis may be addressed as well.

Higher testosterone levels can also strengthen a man’s bones and help control blood sugar levels.  In addition to the ability to improve mood, energy level, and reduce irritability and anger, raising testosterone may improve cardiovascular health as well.

Testosterone Replacement Therapy—Treatment Modalities and Types

For the past several years, many physicians have used the synthetic hormone testosterone to help treat low male hormone levels to reverse the age-related consequences that cause “Andropause”.  Prescription sales have reached about $400 million a year now, tripling the number of prescriptions in recent years.  Though this pales in comparison to the $12.5 billion spent on medication to lower cholesterol in this country, numbers are still impressive.

Modalities for testosterone replacement therapy include:

  • Muscular injections—Testosterone replacement through injections in the muscles can be given every two to three weeks.
  • Testosterone patches—Worn on the body, these patches may be rotated between the arms, back, abdomen, or buttocks.
  • Testosterone gel—This can be applied topically to the abdomen, arms or shoulders.

The Rub on Topicals

Because testosterone can be toxic to the liver if taken in pill form it is not available this way.   It can be easily absorbed into the skin however, so is available in gel form to be spread daily on the upper arms, abdomen, and shoulders.  This can be done after a morning shower when the skin is clean and dry.  Gel may also take the place of the more traditional patch, used for hormone replacement treatment.

The product, Striant is a gel specifically designed for application to the gums.   The FDA regulates this as a controlled substance, however.

Low Testosterone—Conservative Treatment

Urologists and other health practitioners have differing opinions about what constitutes low testosterone levels in males, and when hormone replacement therapy should be explored.  Some take a more conservative approach and consider the following:

  • A reading of below 200 ng/dL for men over 65, whereby three early morning tests reflect these subnormal numbers.
  • While men with low testosterone levels, (200–300 ng/dL) may, in fact benefit from testosterone replacement therapy, some physicians may chose to treat only men with very low testosterone levels.
  • Urologists and health practitioners should monitor testosterone levels carefully since testosterone deficiency symptoms are very general.  These include, diminished muscle mass, fatigue, depressed mood, and low libido.  By measuring testosterone levels physicians can tell whether hormone replacement treatment is working.
  • Optimal testosterone levels for men over 65 should be 300–450 ng/dL, which is the mid range for that age range of males.
  • Doctors vigilantly monitor diseases and conditions that are dependent on testosterone such as, prostate cancer and prostate enlargement.  Medical conditions such as, sleep apnea, breast tenderness, and elevated red blood cell counts should also be followed.

Alternate Approach—Same Destination?

Some physicians take a broader approach to hormone replacement therapy for males.

  • Many urologists place the cutoff at 400 ng/dL for low testosterone, rather than 200 ng/dL.
  • Some urologists allow the symptoms to guide them on whether or not to treat patients for low testosterone therapy.  They use hormone levels as additional backup information instead.
  • Some physicians emphasize more natural regimens such as, regular exercise, to keep cardiovascular systems in shape, help keep bones strong, build muscle mass, and keep off fat.

Q & A

Question: Do aging men go through “manopause” similar to what women have with menopause?


Fewer spontaneous erections, more naps, and a belly that’s threatening to hang over the belt line…Yes, men experience physical and psychological changes in midlife that can in some ways mirror the menopause that women go through.

The proper term, “andropause”, from the Greek word andro (male) and pausis (stop) involves the gradual process of slowing down as hormone levels diminish or change in noticeable ways by middle age.

Testosterone and DHEA

As hormones (known as androgens) necessary for strength, vitality, health and well being taper off, a subtle, downward shift in energy level and virility is felt.

Testosterone: Considered the most potent of all androgens and the foundation for male characteristics, testosterone is created in the testes and responsible for facial hair, the deepening of the voice, muscle mass and bone density, sexual function, stamina and competitive drive in males.

DHEA: (dehydroepiandrosterone) produced in the adrenal glands builds protein and helps with immune function in the body. It is also considered a precursor to other hormones like testosterone and estrogen, meaning that it can be converted to these hormones if levels in the blood are insufficient. The hormones cortisol and DHEA balance each other to maintain the immune system as well.

There are several reasons that the natural aging process may cause the overproduction or reduction of certain hormones in the male body. One of the important reasons involves the enzyme, aromatase. This essentially converts testosterone to estrogen in the male body, causing free testosterone levels to decline, as estrogen rises.

Other factors include:

  • Increase in belly fat (which increases aromatase activity)
  • Damage to tissues that are responsible for testosterone production
  • Reduction in the synthesis of testicular testosterone
  • Lower levels of precursors, such as DHEA
  • Changes in liver function and status of nutrition

Some men explore hormone replacement therapy in response to difficult symptoms that negatively impact their life.


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