Androgen replacement therapy

Male hormones are called androgens from Greek words anthropo and andro meaning man, and gen meaning giving birth to. Primary among them is the natural hormone testosterone, which is produced in the testes and adrenals. Females also produce testosterone in the adrenals and as a precursor to estrogen, but the amount of circulating testosterone is far less than in males. Both sexes also produce an androgen precursor called dihydroepiandrostene (DHEAS) from which the body can make androgens. Androgens cause the secondary sex characteristics of males: facial hair, thicker skin, (aggressive drive), low body fat, deeper voice, muscularity, penis and scrotal growth and darkening, broad shoulders, body hair, erection of the penis, etc. With age testosterone production declines. As many men enter middle age they feel symptoms caused by a relative decline in testosterone: fewer erections, fatigue, thinning skin, declining muscle mass and strength, more body fat. This has led to a demand for 'androgen replacement therapy' (ART) which is essentially a perceived need for artificial, external supply of androgens to be given in order to restore the body and mind to a more 'young male' state.

This 'decline of maleness' with age has given rise to a term: 'Andropause' to be equated with menopause in women. The term manopause has also been used in the popular press. There are several artificial androgens, including nandrolone and various other manipulations of the testosterone molecule. Androgen replacement is via patch, tablet, pill or cream; or depot injections given into fat or muscle.

Users report an increased alertness and well-being, heightened libido and erection ability, increase in lean muscle mass and concomitant decrease in body fat, among other benefits.

The controversy arises around several issues. First, it is an artificial prolongation of testosterone-driven characteristics (or 'youth') and therefore by definition philosophically suspect according to some beliefs. Another philosophic or ethical issue concerns equity of distribution: if androgens benefit older men who have to pay significantly for them this may lead to a two-stratum society in which the rich can afford the drugs and the poor cannot. ART is also dangerous in a practical sense: androgens raise the blood pressure, thicken the blood, raise cholesterol and promote prostate cancer, among numerous other effects. Other effects include baldness, facial flushing, salt and water retention and prostatic hyperplasia. Then there is the possibility of abuse: people getting far higher levels of androgen than normal in order to out-perform others or to achieve a perceived well-being. Abuse of androgenetic steroids can lead to roid rage in which there is a lowered threshold for violence and rage in users.

Androgen replacement is also used for males who have lost their testes to disease or cancer or to other causes.