Should men get testosterone over the counter, too?

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After years of pregnancies, women going through menopause may receive one form of over-the-counter hormone replacement therapy (HRT). Each year, around 1.5 million middle-aged women in the UK experience unpleasant menopausal symptoms, including hot flashes, night sweats and disturbed sleep.

Until now, women were only able to access HRT – a treatment that can treat some of these problems – after consulting with a general practitioner or specialist. But now, the Medicines and Healthcare products Regulatory Agency (MHRA) has launched a public advisory about whether vaginal estrogen tablets (a form of treatment) should be available from pharmacies.

It’s an exciting advertisement for a lot of women. But some are now asking: What about men?

In recent years, doctors have become more interested in what some describe as the male version of menopause: the gradual decline in testosterone production that men have experienced since middle age. Symptoms of low testosterone in men are rarely as severe as those caused by menopause in women. Testosterone decreases gradually, little by little each year, while the menopause in women is more dramatic.

But nevertheless, low testosterone can cause serious problems in sufferers. Men describe mood swings, irritability, low energy, loss of muscle mass, difficulty sleeping and poor concentration, according to the NHS. Some notice changes in the distribution of their fat, with the appearance of a large belly or gynecomastia (often known as “man boobs”).

Testosterone is a hormone produced in the male body, which is important for bone strength, sex drive and maintaining muscle mass. Women also produce it, but at much lower levels (between one in ten and one in twenty as many as men). Testosterone is emitted mostly by the testicles. Production increases rapidly during male puberty (which is why some teenage boys spend a lot of time thinking about sex), before peaking in their twenties. After that, it usually remains stable until the age of 40, when it begins to decline by about 1 percent each year.

Low testosterone affects about one in 10 men between the ages of 40 and 60, and one in five between the ages of 60 and 80. Men under the age of 40 are less likely to be affected – but it’s certainly unheard of. Singer Robbie Williams was in his 30s when a doctor told him the testosterone level of a man was in his 80s, his wife Aida Field revealed in 2018. Williams initially consulted a doctor with symptoms of depression.

Now that women can buy HRT without a prescription, some doctors are wondering if it’s time for low testosterone to receive more attention, too. “There is a fundamental lack of awareness and understanding surrounding the importance of testosterone in physical and psychological health,” says Dr. Robert Stevens, who directs the Men’s Health Clinic in Dorset, a private clinic that specializes in testosterone deficiency. “A lot of these guys [with low testosterone] They addressed their lifestyle, diet, and training. They don’t feel the benefits, because testosterone is the building block of your physiology.”

Currently, the approach to treating low testosterone in the UK seems chaotic and disjointed. It is difficult to get a diagnosis through the NHS, as symptoms are easy to confuse with symptoms of depression – as is the case with menopause in women. Men with low testosterone are often misdiagnosed as having anemia, chronic fatigue, liver disease, heart failure, insomnia, or chronic fatigue.

Diagnosis requires a special blood test; It cannot be inferred from other tests. And even if you do a testosterone test, there is little agreement in the UK on how to determine the stopping point for treatment.

This approach may seem somewhat random, says Stevens. “He. She [depends on] Where do you live, which doctor do you talk to, whether you’re meeting with an endocrinologist, an andrologist (male health professional) or a urologist. It’s kind of like a lottery right now; There is no unanimity of opinion.”

Men with the most severe symptoms may be prescribed testosterone replacement therapy (TRT), a medication given by gel or by injection.

But Stevens is concerned that the inconsistent approach across the NHS means some men are not prescribed TRT in a timely manner. Some general practitioners still mistakenly view testosterone as a performance-enhancing and lifestyle drug that bodybuilders take to increase size, he says. “Education is the key. If clinicians and the general public had a better understanding of the importance of testosterone in physical and psychological health… that would go a long way.”

But he doesn’t think testosterone should be available for purchase without a prescription. “We already know there is potential for abuse,” he explains. “The damage can be caused by too much testosterone.”

In fact, in 2014, the US Food and Drug Administration issued a warning in 2014 about the increased risk of heart attacks and strokes due to the use of testosterone replacement therapy, although other studies haven’t come to the same conclusion. The US Food and Drug Administration (FDA) stresses that more research is needed.

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