Are You Man Enough?

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Some researchers are taking seriously the still controversial notion of "male menopause," a constellation of physical changes, including fatigue, depression and drooping libido, that they believe can be traced to the decline of hormones, including testosterone, in men over 50. Others are not so sure. "One thing we have to recognize is that the decline in testosterone is also intertwined with changes, such as decrease in blood flow, and psychological and social changes too," says Dr. Kenneth Goldberg, medical director of the Men's Health Center in Dallas. "Simply expecting to take men who are androgen deficient and expecting testosterone to fix it all--it just can't be."

Yet even the passage of time doesn't guarantee that a particular man's testosterone will decline to a level that much affects how he feels, at least not by middle age. Middle-age men who preserve the body weight they had in their 20s may have no falloff at all, while overweight adult men of any age tend to have lower testosterone levels. This means that a couple of the goombahs on The Sopranos are probably deficient, though maybe I should let you be the one to tell them that.

Once you get past the proven links between testosterone, libido and muscle mass, the benefits of having higher levels of testosterone become harder to prove, though no less interesting to hear about. Just how much of a role does this play in producing behaviors such as aggression, competitiveness and belligerence? Men who take testosterone by injection routinely report that in the first days after the shot, when their T counts are especially high, they feel increased confidence, well-being and feistiness--what you might call swagger. They also describe feeling snappish and fidgety.

Jim--not his real name--is a family therapist who was 40 when he started taking the shots because of fatigue and a so-so interest in sex, which had led him to get his T levels tested. The first day or two after the shot, he says, he's on pins and needles. "My fiance knows to steer clear. I tend to be short-tempered, more critical, and I go around the house looking for problems. I live out in the country, so right after I get the shot I get out the weed whacker and the chain saw, and I just go crazy."

Gee. Even putting aside for a moment the much increased danger of prostate cancer, do we really want men to turn later life into a hormonal keg party? The thought could be mildly exasperating to women, who might be forgiven for greeting the news with the same feelings china shop-keepers have for bulls. But this is the point at which the discussion of testosterone veers into the metaphysical.

Outside the bedroom and the gym, just what does testosterone do for you? Studies in animals have repeatedly shown that testosterone and aggression go hand in hand. Castrate species after species, and you get a pussycat. Boost the testosterone with injections and the castrated animal acts more like a tiger. In one study of men, when the testosterone levels were suppressed (in this case by researchers using medications) libido and dominant behaviors dropped. But when a mere 20% of the testosterone was added back, libido and domination climbed to the levels where they had started. Which suggests that men do not need much of the stuff to go on doing whatever it is they have already learned to do.