Of course, Dr Mark Porter has a perfectly valid point. His Times 2 piece (April 22) on testosterone replacement therapy (TRT) highlights inappropriate medical intervention in male ageing.
In America, apparently, you can roll it on.
To be truly efficacious, testosterone (T) has to be given parenterally – that is by ‘injection ‘: skin, after all, is designed to be relatively impermeable. Gels and, indeed, capsules, do not deliver the punch needed to overcome serious depletion in males. In short, the transdermal route can do no huge harm but is probably, by and large, homeopathic.
Abuse of synthetic and illicit anabolic steroids, especially in young gym fanatics, can be disastrous. The self-dosing regimes deliver enormous burdens on the endocrine system, in very short bursts, resulting occasionally in irreversible infertility, and almost certainly in dependency.
If given in approved and licensed slow-release formulations – pellet implants or intramuscular depot preparations – men are granted the services of a near-nature third testicle.
50% of men over the age of 50 are T deficient by rule of thumb, substantiated by research dating back to 1939 when T was first introduced as a highly profitable pharmaceutical product.
T is the hormone of ageing, as from 28 it falls inexorably: fighting, fucking and hunting becomes increasingly problematic. Recently Cambridge University found a profound difference in mortality rate between the upper and lower levels of T for the age range 40 to 70 – the higher the level, the lower the deaths, especially from cardiovascular disease.
There appears to be no association between the occurrence of prostate cancer and normal levels of T. Indeed, there is growing evidence that low levels of T are associated with the more malignant forms of prostate cancer. It could be that T is protective in more ways than several.
The one major hurdle in this inevitable academic cockpit is the precise diagnosis of hypotestosteronaemia, or ‘hypogonadism ‘. It is little to do with the total T as measured by a laboratory: it has everything to do with the free T, the bio-available T, the little bit of T that does the business.
Around 98% of the total T is stored on large protein molecules in the blood – appropriately named ‘sex hormone binding globulin ‘ (SHBG). If T was stored in the testicles, they would have to be the size of charentais melons – problem.
As T production naturally decreases, SHBG naturally increases with age – therefore, less and less free and active T, therefore, less and less fighting, fucking and hunting – tough.
There is a wide range of symptomatology, and men have to listen more to themselves and less to ill-informed doctors: treating T depletion has to be a co-operative team effort.
There is not a tissue in the human body that does not have T receptors – even the nailbeds of toes – but most important of all the brain and the musculo-skeletal system: we are touching here on senility and decrepitude.
T supplementation is a long-term commitment for both patient and doctor. Doctors have only been able to measure T for the last 25 years on a routine basis – not long, and laboratory hormone investigations are expensive. T supplementation for men is also expensive. Naturally many doctors are often reluctant to get involved.
Men with the symptoms of low T often have an up-hill struggle: it is a hard negotiation more often than not. But we have to persevere – and ‘NICE ‘ approves.
But the message is to make sure that investigations are thorough, and are understood by both of the two in the team: men ‘s health in almost all its aspects is at stake, along with continuing vigour and vitality into an indecent old age.