Should your grumpy old man be on HRT? Despite doctors’ concerns,growing numbers of men insist testosterone jabs have transformed their lives

The Daily Mail 1 January 2014

Like many men in early middle age, David Quincey felt the best years of his life were already over.
At 42 he was putting on weight. He was depressed and irritated by the demands of his teenage children. He felt tired out, unsexy and generally past it.

‘I was losing muscle mass and replacing it with fat,’ he says. ‘In 18 months I went from 14st to 16½. I was snappy, which I put down to being tired. My libido went down to zero. I had all sorts of irrational anxieties. I was waking up several times a night.

‘Then I developed excruciating sciatica, a swallowing problem and heart palpitations, so I started taking time off work.’

The days off work turned into weeks, then five months. He went repeatedly to the doctor in the search for help for his multiple unexplained symptoms, and, after a cardiac investigation, was prescribed powerful medication to control his heart rhythm, plus anti-depressants and painkillers.

David — now 46 — is a skilled senior craftsman with years of valuable experience, specialising in installing wooden dashboards in luxury cars. Luckily his employers, Jaguar Cars, were sympathetic. They put his health problems down to stress and sent him to a counsellor.

Eventually, further tests revealed that David, from Tamworth, Staffordshire, who’s been married to his teenage sweetheart Sharon for 25 years, was suffering from low testosterone, a controversial condition some specialists believe affects up to one in five men over 40.

Although there has been no long-term research, and many specialists are sceptical, an increasing number of doctors are beginning to offer testosterone hormone replacement therapy (HRT) to men, in exactly the same way HRT involving the female hormones, oestrogen and progestogen, is offered to women.

While women also need low levels of testosterone, in men, the hormone is key to producing the characteristics of masculinity — sperm production, body hair growth, and muscle and bone strength.
Levels may decline with age and in men suffering from obesity or diabetes, but there is little agreement among doctors about whether or when this should be treated.

What is certain, however, is that more than 300,000 NHS prescriptions for testosterone replacement are now being written every year, a five-fold increase since the early 1990s. The most recent figures show spending on the treatment rocketed by £4 million to £16 million in 2011-12 alone.

The new trend reflects the fact that while it’s commonly accepted that female hormones, oestrogen and progestogen, decline with age, it has only recently been considered that the much smaller testosterone decline in men might also be worthy of treatment.

Like oestrogen in women, testosterone levels in men have a protective effect on bones, meaning HRT could be useful to reduce the progression of the brittle bone disease osteoporosis, which affects one in five men over 50, and causes thousands of deaths.

‘When men get it, they do seem to get it particularly badly,’ said Julia Thompson, a specialist nurse at the National Osteoporosis Society. ‘In about half of all cases it is the result of a secondary cause, which may be testosterone deficiency.’

HRT for women has, of course, become increasingly controversial because of fears of side effects such as increased risk of cancer, heart disease and stroke.

These fears were based on results from several now discredited trials — meaning the latest advice is that women at risk from osteoporosis or suffering other menopausal symptoms including hot flushes, loss of energy and low libido, should still be offered HRT.

However, HRT in men is even more controversial because there have been no long-term trials of testosterone use, and many doctors do not accept that men even suffer anything more than a very slow decline in testosterone levels.

Indeed, many also believe that testosterone, a drug routinely abused by body builders and athletes because it boosts oxygen-carrying red blood cells, can increase the risk of heart disease and strokes because too many red cells can fatally thicken the blood.

There are also fears that testosterone can trigger cancer, because it may stimulate abnormal cancerous cell growth in the prostate — the sperm-producing gland in men — in the same way that oestrogen can stimulate the growth of abnormal cells in the ovaries.

But many men, like David, insist that their life has been transformed by HRT.

It was only last year, when he mentioned the absence of a sex life, as well as his depression and muscle weakness to the doctor, that the GP decided to do a blood test to check his testosterone.

‘When the results came back, the doctor said I probably had a lower testosterone level than my grandmother,’ says David, who has a 20-year-old daughter and an 18-year-old son with Sharon.
A healthy testosterone level — measured in millimols per millilitre of blood — is more than 12. A level of 8-12 is considered abnormal, and below eight is considered dangerously low.

Low testosterone is associated with loss of muscle and the development of fat, low energy, low mood and loss of sex drive — much the same symptoms associated with low oestrogen in women.
David’s initial test result was just 6.7.

He was referred to Geoff Hackett, a consultant urologist at the Good Hope Hospital, near Birmingham, who is also professor of men’s health at the University of Bedfordshire, and a leading advocate of greater use of testosterone HRT. Professor Hackett gave David a testosterone injection and prescribed similar boosters every 12 weeks. The painful and undignified injection into the bottom takes up to 30 seconds, but David says it was worth it.

‘I started to feel better within two days — it was incredible,’ says David, who is once more back down to 14 stone in weight.

‘My sex drive came back better than before. I wasn’t depressed and all the other problems went away. I’m not taking any other medication any more and I’ve had no more time off work.

‘The only drawback was that the testosterone injection would wear off before the end of the 12 weeks. Now I get testosterone gel to keep me on an even keel. I rub it on my arms every morning after I have a shower, then put my shirt on and go off to work.

‘I was told that the way I was going before I started on testosterone, I would have died from heart disease within ten or 12 years.’

Professor Hackett says he has prescribed HRT to thousands of men over the past 18 years, but it’s only recently that slow-release injections and gels have become available, allowing the hormone to be absorbed through the skin in a reliable dosage.

‘Low testosterone levels are often linked to being overweight,’ he says. ‘We know that overweight men die younger, but we also know that if we give them testosterone their energy levels improve, they feel better and they are more likely to adopt a healthier lifestyle.

‘If we do nothing we are condemning them to die young. As far as I am concerned this is something we should be doing.’

Tam Agnew, a 57-year-old former firefighter, who lives with his third wife Diane, 44, in Chipping Norton, Oxfordshire, agrees.

He was previously taking no fewer than 19 tablets a day for various health problems and is quite certain he would now be near death if his need for HRT had not been picked up.

‘It’s a wonder drug as far as I’m concerned,’ he says. ‘My life has been transformed by it, and I really want to get the message out to other men.
‘I think if all men were screened for low testosterone in their 40s, we could prevent a lot of health problems.’
Tam had to give up work 18 years ago because of crippling early-onset arthritis, which made his physically demanding job — and later any other type of work — impossible.

From being a muscle-bound action man he had become, by 2004, a miserable 21-stone diabetic, unable to exercise and taking daily medication for diabetes, depression, raised cholesterol and pain control.

One of the side-effects of obesity is raised production of hormones that suppress testosterone production. Some doctors say this loss of testosterone leads to greater loss of energy, loss of self-esteem and sex drive, which in turn lead to greater weight gain. If you give testosterone HRT, they argue, you reverse these symptoms, and men with more energy are more likely to feel good and take more exercise.

Tam has now been on HRT treatment for four years — starting with the gel before moving to injections every nine weeks as well. He has since lost 5st and cured himself of diabetes.
‘I developed erectile dysfunction in about 2006, two years after I developed diabetes. Now I’ve got strength, energy and my sex life back.

‘Diane and I go swimming twice a week for exercise, because I can’t walk far. I still have to take painkillers because of the arthritis, but I have stopped taking all the other medication and everything else is good.’

Tam was given HRT by his GP David Edwards, who is also president of the British Society for Sexual Medicine.

‘We are trying to get the Government interested in this through the men’s health expert policy group,’ Dr Edwards says.

‘Men are very bad at helping themselves and getting medical treatment when they need it, and testosterone deficiency is little recognised or understood. We need to do something about that.’

A general lack of willingness to recognise testosterone deficiency is something Brian Cunningham understands very well.

The 50-year-old from Edinburgh who is single, originally diagnosed the condition in himself by researching his symptoms — dramatic weight gain and severe depression — on the internet, before persuading a hospital specialist to prescribe him HRT.

‘I have been on it for two years and without it I wouldn’t be here now, it’s as simple as that. I believe it has saved my life,’ he says. ‘The GP had measured my testosterone and it was at level six.

‘The specialist I eventually saw said I should lose some weight and come back in six months. I said I would have committed suicide by then.

‘I told her that her boss had published research recommending testosterone in cases like mine. She went off to get a second opinion and came back to say I could start on it immediately. I have to rub the testosterone gel on my arms and chest every day. I felt better within a week or two of starting, and I couldn’t be without it now.’

Brian’s original health problems began five years ago, when he suffered a serious back injury after slipping over and fracturing a vertebra in his spine.

It was his first holiday for more than two years, after working flat out setting up a pub business.
It took months of immobility for the fracture to heal, and when he got back on his feet again, he was constantly tired and weak. He decided to start training at a gym but found himself unable to lift even 6kg — the weight of a three-month-old baby.

‘It was as though the weight was stuck to the floor,’ he says. ‘I was very unfit. My size had already started to become a problem. I had been living on hospital food for ages, and just lying around snacking.’

He had ballooned from 15st to 34st, and was suffering from severe depression, not to mention what he describes as ‘considerable physical and psychological pain’.

Thanks to the HRT, his testosterone level is now a healthy 15, he has so far lost 4st, and he has a new job as a science technician in a large secondary school.

‘Before I couldn’t see my life continuing, now I feel I have a future again,’ he says.

Not everyone shares the growing enthusiasm for men’s HRT, however.

Richard Quinton, a senior consultant hormone specialist, has warned doctors about the male HRT prescription ‘epidemic’, when little is known about the long-term effects of topping up testosterone levels. ‘Most specialists don’t think testosterone declines much in old age,’ says Quinton. ‘It only declines if men are ill or obese, so many of the men receiving the hormone boosters may not have a deficiency.’

‘There should be better guidelines on who should be treated, and all men receiving testosterone should be monitored via a national registry.’

Fred Wu, professor of medicine at Manchester University, who is famed for his work on the male contraceptive pill and is one of Britain’s best-known male hormone experts, also urges caution as the use of male HRT, like female HRT, may actually increase the risk of heart disease and cancer.

He adds that while doctors are noticing low testosterone levels in more and more men, they may be a symptom — rather than a cause — of other health problems, including diabetes and obesity.
‘There are some studies showing people with low testosterone have higher mortality rates, but there are also studies suggesting the reverse,’ he says.

‘The risks and benefits are not clear, and many of the regulatory authorities are concerned about the increasing use of it. There have been no long-term studies, and we have to be extremely careful about who we give it to.’