Professor Gary Wittert has debunked the myth of male menopause and says health practitioners who advocate the use of testosterone replacement therapy are selling men short and missing serious underlying medical challenges.
Director of the Freemasons Foundation Centre for Men's Health at the University of Adelaide, Professor Wittert told ABC Radio Hobart this week that there is no equivalent of menopause in blokes, where there is a sudden cessation or drop of testosterone levels.
“If men stay healthy with increasing age, testosterone changes very little,” he said.
“But, if you accumulate more chronic diseases and/or bad habits, then your testosterone levels will fall.
“It’s more a reflection of the other things that happen to you with the passage of time than age in and of itself. In that sense, it’s acting as a marker of bad health.”
Professor Wittert said obesity was a major risk to decreasing testosterone levels, along with poor eating habits, lack of exercise and sleep, excessive drinking and depression. Addressing lifestyle habits and mental health can improve testosterone levels.
“If you have sleep disruption of any sort, it effects your health, and there’s a tendency to blame the low testosterone because they occur concomitantly even though they are not causally linked. There’s a lot of circumstantial stuff that goes on," he explained to host Leon Compton.
Professor Wittert was damning of health practitioners who advocated Testosterone Replacement Therapy (TRT), claiming that a patient’s other problems were left undiagnosed and unmanaged.
“If a medical practitioner is working on the assumption that the center of a male universe revolves around testosterone, they are missing the sleep Apnoea, they are missing the depression, they are missing the low urinary tract problems, they are missing the pre-diabetes, they are missing doing something about the obesity, they are missing the underlying risk factors for heart disease and they are missing the excessive alcohol consumption, which is a very frequently associated problem.”
On the depression issue, he said the likelihood of suicide in men was considerably higher than in women, whereas men were less frequently diagnosed with depression.
“So that means men with depression are not being diagnosed in primary care and the reason is because they present differently.
“If you’ve got a whole lot of practitioners believing that depression in men is a marker for low testosterone, and therefore treat the testosterone, that does an enormous disservice to men’s health.
“There is the accusation made that men with depression don’t go to the doctor. We’re just about to send a revised manuscript off showing very clearly that men with depression go to their doctors more frequently than other men but it’s a crapshoot whether they get diagnosed or not.”
He said health practitioners should use “a high index of suspicion” in diagnosing depression in men that took into account irritability, aggression, substance abuse and high-risk behaviors that are linked to depression in men.
“Not blaming bad health on testosterone, but blaming the low testosterone on the other factors that are leading to bad health will lead to a much better outcome for men’s health in general.”
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