Testosterone supplements: should you take male HRT to get your sex drive and energy back?

Prescriptions for testosterone have become big business in the US, but doctors and researchers here can’t agree whether it’s safe or not. Jerome Burne looks at the evidence for and against

The late great George Melly – expert on surrealism, sexual revolutionary and singer with the jazz band The John Chilton Feetwarmers – described his relief when his libido began to diminish as he got older. “It was like becoming unchained from a maniac,” he wrote in his autobiography Rum Bum and Concertina. But they only separated after years of wild fun times.

However, while George wasn’t interested in trying testosterone replacement – the best known sexual pick-me-up for middle aged males – an increasing number of over-50 men are keen on reconnecting with their personal maniac.

In the States, a chain of 49 (and growing) clinics called, casually, Low T centres, have sprung up to service them, promising “power, performance and passion”.

The number of prescriptions for testosterone in America has increased ten times between 2000 and 2011. Low T currently serves 45,000 patients at an average price of $400 a month. This is big business. Patient numbers in the UK are still a small fraction of that.

Low T is just the latest solution for the missing maniac that stretches back into antiquity. It was Socrates who first referred to him. Other fixes have included “garlic and fresh coriander in neat wine” and extract of the testicles of monkeys.

Testosterone is the hormone responsible for the male (and female) sex drive. It also supplies a number of other benefits such building muscle and bones and providing energy and drive. It’s not hard to see the attraction of simply rubbing testosterone gel on to an arm or leg to replace what you are missing when natural production drops off as you head into your sixties.

Why doctors disapprove of testosterone boosts

However, doctors are generally disapproving of male HRT as a way to recover a youthful buzz. Officially you are only eligible if you have a serious deficiency – known as hypogonadism – which comes with increased flab around your middle, a loss of muscle, fatigue and low mood.

A blood test can tell if you are within the normal range of 350ng/dl to 1000ng/dl. But only if you have both the symptoms and you’ve dropped below 150 ng/dl do you tick the hypogonadal box and qualify for a prescription.

Low T and other private clinics operate in the grey area between 150 and 350. Until recently your prescription would come with a firm warning about the possible side effects, which include heart attack or stroke and prostate cancer.

Some doctors have been particularly nervous about hormone replacement ever since a raised risk of heart attack showed up with female HRT in the first big placebo-controlled trial in 2002 – after doctors had been recommending it to all menopausal women for years.

Was the testosterone evidence wrong?

But just recently, several big trials have suggested that the risks of supplementing with testosterone have been exaggerated. Rather than being a cause of cardiovascular problems, it looks like a supplement may lower your chances.

At a conference in October last year organised by the UK’s most persistent promoter of the benefits of testosterone, Dr Malcolm Carruthers, delegates heard a more positive story.

“Testosterone therapy increases blood flow to the heart, improves angina and actually lowers risk factors such as cholesterol, high blood pressure and blood clotting factors,” said Professor Tom Trinick, consultant general physician at Ulster hospital.

A researcher at Klinikum Braunschweig in Germany found exactly these benefits in a study of 261 patients followed for five years; they also lost weight.

Such results have made testosterone replacement even more controversial. In February last year an article in the British Medical Journal called for a ‘black box’ warning to be placed on testosterone packaging following a study of 55,000 men by the American National Institutes of Health which found that testosterone doubled their risk of a heart attack.

But other hormone experts, such as Dr Scott Hackett of Birmingham Heartlands Hospital, responded by highlighting serious flaws in the way the study had been done. Then, last summer, a study at the University of Texas of 25,000 older men who had been on testosterone for up to eight years found no increase in the risk of heart attack at all.

Even global regulators disagree

Confused? So are the doctors and the regulators. Currently both the American FDA and the European Medicine’s Agency say that there is no consistent evidence that testosterone supplements are linked to an increased risk of heart disease. But the Canadian drug watchdog, Health Canada, warns that testosterone can cause life-threatening heart problems. So take your pick.

Further evidence that testosterone could protect against heart problems came last October from a study on patients with prostate cancer who were being given the standard prostate cancer treatment, namely a drug that cuts their production of the hormone.

Researchers at Harvard Medical School found that those who also had some form of heart disease were three times more likely to die from it after having treatment to lower testosterone.

In fact, it is possible that the common warning that testosterone could trigger prostate cancer may also be wrong. A small study by Dr Abraham Morgentaler of Men’s Health Boston several years ago found that men with early signs of prostate cancer who were also getting testosterone for a year got no worse as a result.

“Clearly the traditional belief that higher testosterone necessarily leads to rapid cancer growth is incorrect,” he says.

Is better sex drive worth the risk?

As a journalist I couldn’t possibly give any clinical advice about testosterone. But as a result of what I’ve read I would be very unimpressed if I’d gone to my GP complaining of feeling tired, lacking in drive and with a vanishing libido to be told that testosterone probably wouldn’t do me any good and would raise my risk of cardiovascular problems, and that I’d be better off exercising more and eating a healthy balanced diet.

This was the advice from one doctor in a recent article about testosterone in the prestigious New England Journal of Medicine. My response would be: you can’t possibly know how I’d respond, and there is plenty of expert disagreement over the risks. If testosterone made me perkier in various ways I’d certainly accept the risks and give it a try. That’s what maniacs do.