Huffpost Los Angeles

Featuring fresh takes and real-time analysis from HuffPost's signature lineup of contributors

Glenn D. Braunstein, M.D. Headshot

Manopause: There's Gold for Some in Those Unneeded Hormone Pills, Shots

Posted: Updated:

Are you a male who suffers from tiredness, moodiness, weakness, low libido and failure-to-thrive? Is your stomach getting flabby and are the crow's feet around your eyes getting more pronounced? If so, perhaps you suffer from Manopause due to a combination of your testes' failure to make adequate amounts of testosterone (Andropause), your adrenals failing to make enough dehydroepiandrosterone (DHEA) (Adrenopause) and your pituitary making insufficient quantities of growth hormone (hGH) (Somatopause).

The anti-aging industry has gone wild diagnosing men with nonspecific and virtually ubiquitous symptoms with dubious hormonal deficiencies, which they then proceed to treat at great expense. For people who have a true deficiency, replacing these hormones can be quite beneficial.

However, based upon the known prevalence of hormonal deficiencies, most of the men receiving hormone injections or pills from practitioners of the anti-aging industry are not truly hormone deficient. Yes, they may feel better on the hormones. But much of this is undoubtedly a placebo effect and is this worthwhile when their wallets also certainly will lose a lot of weight from the cost of this dubious therapy. Let's examine each of these conditions and what the science, not the hype, tells us.


First, let's consider some of the normal consequences of aging in males. There is an increase in fat mass, a loss of muscle mass and strength, decrease in bone mineral density and age-related disability including generalized weakness, impaired mobility and balance and poor endurance. Obviously, some men experience these symptoms more than others do.

Testosterone levels in men peak in the 20s, then undergo a progressive decrease over each decade. Levels in an otherwise healthy 75-year-old male are about half of those of a man ages 18 to 24. Knowing this may help explain the jump to the conclusion that some normal, age-related changes in males may be due to low testosterone.

Those with a real problem with testosterone production, a condition known as hypogonadism, demonstrate a progressive decrease in muscle mass, a dip in energy and sense of well-being, a loss of sex drive, increased fat deposition around the abdomen. They also may complain of hot flashes, breast enlargement and may develop osteoporosis. Epidemiologic studies have demonstrated that the prevalence of symptoms and signs consistent with androgen deficiency associated with a low testosterone is found in 2 percent to 6 percent of men, with a higher prevalence in those 70 or older.

Besides sexual symptoms, mobility limitations, increased fall risk and osteoporosis, there also is an association between low testosterone and type II diabetes, a constellation of findings called the metabolic syndrome (abnormal lipids, blood pressure, sugar and waist circumference), cardiovascular disease and mortality.

Treatment of men with a low testosterone associated with signs and symptoms of hypogonadism has been shown to heighten libido, improve erectile dysfunction, boost bone mineral density, enhance the strength in dominant muscles, increase lean body mass and decrease fat mass and improve mood and energy.

But there is no compelling data now to indicate that testosterone treatment reverses type II diabetes or metabolic syndrome, nor that it improves overall physical function, decreases cardiovascular disease or decreases death. It is clear that treatment of men who are not testosterone deficient does not enhance function, though there may be a slight increase in muscle mass and decrease in fat mass, both of which can be achieved by exercise alone.

There are a number of conditions in which testosterone may pose significant dangers.These include men with breast cancer, metastatic prostate cancer, undiagnosed prostate nodules or an unexplained PSA elevation, high hemoglobin,severe congestive heart failure and untreated sleep apnea.

Testosterone is generally administered as gels or patches applied to the skin or by injections given every one to two weeks. The oral testosterone preparations now approved in the U. S. are not considered optimal therapy, because they may lead to liver problems. There is a preparation that can be placed under the lip but it's unpopular because it can cause irritation and dental issues. Placement of long-acting testosterone pellets under the skin is more popular abroad than in the U.S.

Whatever testosterone therapy is given, patients should be monitored with examination of the prostate, blood counts, lipid levels, and, if patients have osteoporosis, a bone mineral density exam should be carried out in two years.

Though male menopause, also known as andropause, does occur, it requires careful documentation of testosterone deficiency symptoms along with low testosterone levels. Be aware that to document low testosterone, blood should be drawn between 8 and 10 in the morning because levels typically drop in the afternoon and evening; normal ranges are established for morning levels.The hormone also should be measured by a reliable method, as there is a great potential for inaccuracy. It's crucial for patients to be assessed correctly before starting this therapy. It can be safe and should ease symptoms, if they're truly due to testosterone deficiency.


The adrenal glands produce several types of hormones including: cortisol, which is important for multiple metabolic processes; aldosterone, which helps control blood pressure and salt and water metabolism; and DHEA, which is converted into androgens and estrogens in various tissues.

As with testosterone, normal aging is associated with a progressive decline of DHEA levels from the 20s to age 70 or 80. Thus, a normal 60-year-old man will have a DHEA blood level that is substantially lower than that found in a 20-year-old. It may be inappropriate to use the young man's normal range to say that the 60-year-old's is abnormal.

Still, this often occurs with the anti-aging industry. Randomized, double-blind, placebo, controlled trials have failed to demonstrate a benefit in regard to weight, body fat, muscle mass, muscle strength or quality of life.


Growth hormone (hGH), also known as somatotrophin, is made by the pituitary gland and is the main hormone responsible for growth throughout childhood and adolescence. It actually works by telling the liver and other tissues to make another hormone called Insulin-like Growth Factor-1 (IGF-1).

Both hGH and IGF-1 levels decline with age. Men with structural defects in the pituitary gland due to tumors, vascular accidents and other causes often develop hGH deficiency. It can lead to increased fat mass, decreased muscle mass, reduced exercise tolerance, osteoporosis, higher cardiovascular disease and impaired quality of life.

In such individuals, treatment with daily hGH injections reverses many of these problems.

Growth hormone treatment is a mainstay of the anti-aging industry, with claims that it can rejuvenate aging bodies.Well, the data just don't support the claims. In otherwise healthy, elderly males, there is a slight increase in weight and lean body mass and slight decrease in fat mass but no significant effect on bone density or strength.

This hormone has substantial side effects, including causing glucose intolerance or diabetes, carpal tunnel syndrome, breast enlargement and coarsening of the face.

In the early 1500s, Ponce de Leon discovered Florida while searching for the Fountain of Youth (although many authorities believe that he was more interested in finding gold and expanding the Spanish Empire). Five centuries later, the anti-aging industry has picked up the conquistador's mantle, only now they are selling the elusive Fountain of Youth to healthy but aging men, while also lining their own pockets with gold.