Testosterone replacement therapy (TRT) continues to be a major controversy in medicine. TRT is controversial for a number of reasons. While nearly every medical doctor accepts the fact that women undergo major hormonal changes with, or more specifically after menopause, which refers to the cessation of menstrual functions in women, many do not accept that a similar scenario exists for men. In women, the major hormonal change, which occurs at an average age of 51, is a decline in the production of estrogen. Estrogen is produced in both sexes, but women produce far more than most men. I say "most men," because some bodybuilders on high-dose anabolic steroid regimes have been known to produce estrogen levels higher than that produced by most women. That is caused by the conversion of certain steroids into estrogen by way of the ubiquitous aromatase enzyme, which converts androgens into estrogen. A lack of sufficient estrogen can cause a host of problems in older women, such as hot flashes or vasomotor instability, problems with vaginal lubrication, possible brain problems, and more. These effects of estrogen deficiency are considered important enough by physicians for them to prescribe estrogen replacement therapy to women. While there is some controversy also associated with estrogen therapy, such as possible adverse cardiovascular effects, the benefits for women are considered enough to outweigh any negative health outcomes. In addition, estrogen replacement therapy has been refined over the years to minimize potential serious side effects, such as cancer.
Yet, when it comes to men, most physicians take a radically different approach. Many think that the decline in testosterone that occurs in men at a rate of 0.4 to 2.0% per year after age 30 is a natural phenomenon that doesn't require medical treatment, and certainly would not justify supplementing men who show clinically low testosterone levels with testosterone. The average man in his 70s has testosterone levels that are 35% lower than younger men, and some older men barely show any testosterone production at all. There are various reasons for this, but these are beyond the scope of this article. Suffice to say that most men over the age of 40 show a decline in testosterone production. The extent of this decline will determine how many feel. For unexplained reasons, some men show deficient levels of testosterone, as measured by lab tests, yet show little apparent evidence of this decline. Yet, a closer inspection of such men always reveals more subtle signs of testosterone deficiency. These can include unexplained depression, loss of sexual drive and function, and most disconcerting of all, a gain in body fat accompanied by a loss of muscle mass. Men who complain about these effects to doctors are told that they are merely experiencing a normal aspect of the aging process and that they should just accept the inevitable. Yet, this isn't the advice told to women, who are provided with estrogen replacement therapy without any medical admonitions . . .