Low estrogen and 'male menopause'

September 11, 2013

By MARILYNN MARCHIONE AP Chief Medical Writer

TV ads tout testosterone treatments for "low T," but surprising new research shows a different hormone may play a role in less sex drive and more fat as men age. Estrogen -- the female hormone -- is needed by men, too, and the study gives the first clear evidence that too little of it can cause certain "male menopause" symptoms.

"A lot of things we think are due to testosterone deficiency are actually related to the estrogen deficiency that accompanies it," said Dr. Joel Finkelstein of Massachusetts General Hospital. He led the U.S.-government funded study, which appears in Thursday's New England Journal of Medicine.

Testosterone is the main male sex hormone. Men's bodies convert some of it into estrogen, and levels of both decline with age. Until now, there was no way to tell which hormone was responsible for complaints of diminished libido, strength and energy.

Millions of men have been prescribed testosterone gel, patches or shots for these problems, but it's not known how much they need or whether this hormone replacement therapy is good, bad or neutral, Finkelstein said. Doctors don't usually prescribe estrogen to men; the way to remedy low estrogen is to give them testosterone and let the body convert it.

The study didn't test hormones as therapy, but explored which ones had which effects. It involved 400 healthy male volunteers, ages 20 to 50, who were given monthly shots of a drug to temporarily reduce their testosterone production to pre-puberty levels. They were then given various doses of testosterone gel or a dummy gel to use. Half also were given another drug to prevent testosterone's conversion into estrogen.

Designing the study this way allowed researchers to compare the effects of different levels of each hormone on things like strength and body composition.

After 16 weeks, researchers saw that muscle size and strength depended on testosterone, body-fat mass depended on estrogen, and both hormones were needed to maintain normal sex drive and performance.

The results mirror animal research -- mice altered so they don't make estrogen grow fat and have no sex drive. And in male-to-female transsexuals, "there's actually evidence that when those men are given estrogen, it helps their libido," Finkelstein said.

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Low estrogen and 'male menopause'