When we age

When we age, the available amount of the male sex hormone testosterone declines.

What are the consequences and is it reversible or avoidable?

On the path to the shopping mall, a small bent fragile man shuffles behind his rollator. His movements appear a little bit slowed down. His clothes fall a little to wide.  With his small somewhat pale and entered face, he sometimes looks on a small note as to remember why and where he is. With the feeling that he can be blown away if the wind will get a bit stronger, I carefully pass the fragile bent guy, fearfully not to disturb or hit him. I start to wonder will this be my future? Will I end looking like this? This man must have been much stronger and taller when he was younger. These by all of us recognizable fragility is a consequence of gradual changes of the body when you grow older. Gradually you loose your power and stamina. Your resilience declines just like the amount of workload you can cope. What causes this fragility? What makes the difference between growing old but staying vital and being able to perform well until high age, and becoming so “fragile”?

Different causes appear to exist. Chronic illnesses as diabetes, rheumatism and artrosis (the “wear” of joints) seem to contribute. Normal age related changes of the body like the menopause/andropause seem to accelerate the  ageing process. Social factors like the housing, the availability of sewerage and clean water supply, hygiene and feeding play an important role. When we see the populations of the third world on the television programs, you will notice that many people there have grown old very early. The hard life demands its tope. There are however also biological factors that can cause this fragility. There are strong scientific indications that there exist a strong age related amount of free available testosterone and fragility. These testosterone levels remain stable until about the age of 55. After that the content decreases with approximate a percent per year. With aging also a larger part of this testosterone is bound by proteins (SHBG) and  less available for normal metabolism pathways. Consequences of  this decrease in available testosterone is loss of muscle mass, a decrease in bone density (osteoporosis),  faster fatique, decreased blood content, decreased psychological and intellectual access ability, an  increase in fat more specific the fat around the bellies and more heart and vascular diseases. These consequences lead to illness and eventual to death. Some man develop a depression or catch wounds and fractures caused by this loss of power and osteoporosis. For many man this testosterone shortage leads to a decreased happiness with their lives caused by handicaps, a decreased appetite, loss of activities, loss of autonomy, loss of libido and a decrease in smell and taste. Woman undergo a menopause, but for man there no such thing as “andropause”. There is however a gradual deterioration of the hormonal functioning by man, but there are large differences between mutual individuals. By 20 % of man above 60 years we find a testosterone level that lies under a, as normal supposed, level. By (chronic) illnesses, we often see a low level. With this drop in testosterone level we see a decreased libido. Should we leave it by this, or should we try to do something against it? After all there are factors in play that determine how we grow old. We all are eager to grow old, but then in a as healthy as possible state. The supplementation of extra testosterone to older man has also side-effects such as fluid retention, the worsening of a maybe already present prostate cancer and a developing of female breast tissue. On this moment it is still not sure if man in the future standard will receive extra testosterone. It is also not clear yet, which forms of testosterone best can be given.  Maybe that in the near future, we will develop testosterone alike matters, which work better and with less side-effects. On this moment, extra testosterone is given by serious phenomena of fragility and osteoporosis. Also supplementary testosterone is given by men with sex related complaints like a loss of libido mediated  by a too low testosterone level. The testosterone is given by means of tablets ( Andriol or Proviron) that must be swallowed daily, by means of a two weekly injections (Sustanon or Testoviron) or by testosterone patches (Testoderm) that must be applied daily on the (shaved ) scrotum.

A sudden gust does stagger the little guy. I already want to rush forward to catch him, but he manage to stay on his feet. Would he have been more mobile and stronger if he had started hormone replacement therapy (HRT) on a younger age is impossible to say afterwards, but is surely possible. Over ten or twenty years we will know more.