Testosterone Gives Some Men Back Their Pep, Study Finds

Testosterone can help some men get back a little of their loving feelings, and helps them feel better in general, according to a new study published Wednesday.

The effects are modest, and men didn't objectively get any more vitality, although they felt like they did, the government-funded study found.

It's the first study in years to show any benefit for testosterone therapy. The Food and Drug Administration has previously warned against over-promotion and overuse of testosterone replacement products, saying they can raise the risk of heart disease.

"This was the first time that a trial demonstrated that testosterone treatment of men over 65 who have low testosterone would benefit them in any way," said Dr. Peter Snyder of the University of Pennsylvania, who helped lead the study team.

"The trial showed that testosterone treatment of these men improved their sexual function, their mood, and reduced depressive symptoms—and perhaps also improved walking."

The FDA does not approve the use of testosterone to treat the effects of aging. But it's already a $2 billion industry, with millions of men buying gel, pills or getting injections.

Experts stress that the results, published in the New England Journal of Medicine,only apply to men over 65 who have medically diagnosed low testosterone. And it was a small trial, including fewer than 800 men, so it's not clear if their heart risks went up.

A few men had heart attacks or were diagnosed with prostate cancer during the study, but the rate were about the same in men who got real hormone and in those who got placebo cream.

Researchers across the country gave testosterone gel or a placebo cream to men who had demonstrated loss of the "male" hormone. They got enough to return testosterone levels to the mid-normal range for men 19 to 40 years old.

"Men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved since the beginning of the trial," Snyder and colleagues wrote.

"Testosterone treatment showed no significant benefit over placebo with respect to vitality," they added.

"Men who received testosterone reported better sexual function, including activity, desire, and erectile function, than those who received placebo. Although the effect sizes were low to moderate, men in the testosterone group were more likely than those in the placebo group to report that their sexual desire had improved."

The effects on sexual performance were not as marked as erectile dysfunction drugs such as Viagra and Cialis, the researchers found.

"However, testosterone was associated with small but significant benefits with respect to mood and depressive symptoms. Men in the testosterone group were also more likely than those in the placebo group to report that their energy was better."

As men age, their bodies make less testosterone. It's not as sudden as when women lose estrogen, but the effects can be similar - loss of energy, sexual desire, depression and bone loss.

Dr. William Reilly, an orthopedic surgeon in Southlake, Texas, said it happened to him.

"I hit a brick wall when I was about 62 years old,"said Reilly, who is now 68.

"All of a sudden my energy level just wasn't the same. I'd wake up and I just felt tired and I'd be going to work and by the second case I'd be getting a little bit of brain fog," Reilly told NBC News.

He started getting less out of his gym workouts. "My arms were starting to get smaller. My belly was getting bigger," Reilly said.

So did Ed Stevens of Ft. Lauderdale, Florida.

"At about age 55, which was about almost eight years ago, I was fatigued, I was getting depressed — which is not like me," Steven said.

Stevens who at 63 would not be considered a candidate for the therapy according to the trial findings, said the hormone helped him feel better.

"I wouldn't call it a huge difference," he said. "I just saw over the months my body mass came back to where it was, my energy was better, libido was a little better."

Results are expected later from four other related studies, which tested the hormone's effects on mental function, bone density, heart function and anemia. 

Read the full study article here.

Click to get the complete guide to Low T: Symptoms, Causes, and Treatments.

Why To Exercise Today: Minimizing ‘Menopause Misery’

A new report suggests a path toward reducing “menopause misery”: Give up your sedentary lifestyle.

A paper — titled “Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity,” and published online in the journal Menopause — looks at more than 6,000 women across Latin America ages 40-59. Researchers found that compared to active women, sedentary women (who made up about 63 percent of participants) reported more “severe” menopause symptoms, including hot flashes, joint pain, depressed mood and anxiety and other symptoms like sex problems, vaginal dryness and bladder problems.

Sedentary lifestyle was self-reported (always a possible red flag in a study like this) as less than three 30-minute sessions of physical activity per week; activities included walking, biking, running, jogging, swimming or working out.

From the news release:

The study analyzed data from the Collaborative Group for Research of the Climacteric in Latin America surveys and health records of 6,079 women … who attended one of 20 urban health centers in 11 Latin American countries. The women completed standard questionnaires about depression, anxiety, insomnia, and menopause symptoms. Symptoms on the Menopause Rating Scale (MRS) questionnaire include somatic symptoms … and urogenital symptoms… The women also answered other questions, such as what their activity level and menopause status were.

JoAnn Pinkerton, M.D., executive director of the North American Menopause Society, and not involved in the study, said that being sedentary carries with it all sorts of health risks far beyond menopausal symptoms — from heart disease to some types of cancer. But, she notes, regular exercise can relieve “menopause misery,” and more. In an email, she adds:

Other studies have shown that being active whether women choose gardening, yoga, walking, biking or swimming at least 30 minutes a day improves menopausal symptoms… Being sedentary is bad for your health, physical and mental. Being active every day not only will help you have less severe menopausal symptoms, but it improves mood, coping, and has health benefits as well.

I encourage women including myself to add activity to our days, every day, whenever and however we can. Don’t wait til Saturday or the days you can go to the gym. If you are in your 40s and looking towards menopause, avoid the 12-15 pounds that most women gain by increasing your activity level now.

To be fit and strong after menopause requires women to gradually increase the amount of time and intensity of exercise to get most benefit.

Panel Recommends Depression Screening For Women During And After Pregnancy

On Tuesday the U.S. Preventive Services Task Force released new recommendations on screening for depression in adults, notably calling for depression screening in women both during and after pregnancy.

The recommendations, published in the Journal of the American Medical Association, suggest: “All adults older than 18 years should be routinely screened for depression. This includes pregnant women and new mothers as well as elderly adults.”

Why?

“Depression is among the leading causes of disability in persons 15 years and older,” the task force statement said. “It affects individuals, families, businesses, and society and is common in patients seeking care in the primary care setting. Depression is also common in postpartum and pregnant women and affects not only the woman but her child as well. …The [task force] found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women.”

The government-appointed panel found that the harms from such screening are “small to none,” though it did cite potential harm related to drugs frequently prescribed for depression:

The USPSTF found that second-generation antidepressants (mostly selective serotonin reuptake inhibitors [SSRIs]) are associated with some harms, such as an increase in suicidal behaviors in adults aged 18 to 29 years and an increased risk of upper gastrointestinal bleeding in adults older than 70 years, with risk increasing with age; however, the magnitude of these risks is, on average, small. The USPSTF found evidence of potential serious fetal harms from pharmacologic treatment of depression in pregnant women, but the likelihood of these serious harms is low. Therefore, the USPSTF concludes that the overall magnitude of harms is small to moderate.

Nancy Byatt, medical director at the Massachusetts Child Psychiatry Access Project for Moms(MCPAP for Moms) and an assistant professor of psychiatry and obstetrics and gynecology at UMass Medical School, said the new recommendations “are an incredibly important step to have depression care become a routine part of obstetrical care.”

She added: “Depression in pregnancy is twice as common as diabetes in pregnancy and obstetric providers always screen for diabetes and they have a clear treatment plan. The goal [here] is that women are screened for depression [during pregnancy and postpartum] and they are assessed and treated and this becomes a routine part of care just like diabetes.”

Dr. Ruta Nonacs, who’s in the psychiatry department at Massachusetts General Hospital and editor-in-chief at the MGH Center for Women’s Mental Health, sent her thoughts via email:

In that the USPSTF recommendation recognizes pregnant and postpartum women as a group at high risk for depression, this represents a step in the right direction in terms of ensuring that psychiatric illness in this vulnerable population is identified and appropriately treated. However, there remain significant obstacles to overcome. Research and clinical experience indicate that while pregnant and postpartum women with mood and anxiety disorders can be identified through screening, many women identified in this manner do not seek or are not able to find treatment.

While screening is important, we must also make sure we tend to the construction of a system that provides appropriate follow-up and treatment. Because stigma continues to be significant with regard to mental health issues in mothers and mothers-to-be and because there are concerns regarding the use of medication in pregnant and nursing women, we must make sure that after screening, we help women to access appropriate resources and treaters who have expertise in the treatment of women during pregnancy and the postpartum period.

Unlike the so-called “baby blues” — the feelings of exhaustion, worry and unease that impact about 80 percent of new moms but are often short-lived — postpartum depression can be extreme and longer-lasting. The condition occurs in nearly 15 percent of births, according to the National Institute of Mental Health, and can often require treatment, from psychotherapy to medications.

The New York Times’ report Tuesday says the health panel’s new recommendations are “expected to galvanize many more health providers to provide screening,” particularly as emerging evidence suggests “maternal mental illness is more common than previously thought; that many cases of what has been called postpartum depression actually start during pregnancy; and that left untreated, these mood disorders can be detrimental to the well-being of children.”

And here’s what Mark DeFrancesco, M.D., president of the American College of Obstetricians and Gynecologists, said in a statement on the new recommendations:

The American College of Obstetricians and Gynecologists (ACOG) is pleased that the USPSTF recognizes that screening for depression is appropriate for all adults, including pregnant and postpartum women. ACOG has long recommended depression screening for all women, both as a part of the well-woman visit and during the perinatal period. Specifically, ACOG’s Committee Opinion on Screening for Perinatal Depression recommends routine screening for depression for all women at least once during the perinatal period.

ACOG’s Committee Opinion also adds that women at high risk of depression – for example, with a history of depression or anxiety – warrant especially close monitoring.

Perinatal depression – or depression that occurs during pregnancy or in the first 12 months after delivery – is estimated to affect one in seven women, making it one of the most common medical complications associated with pregnancy. Because fewer than 20 percent of women in whom perinatal depression is diagnosed self-report their symptoms, routine screening by physicians is important for ensuring appropriate follow-up and treatment. Fortunately, we have a variety of treatment options – such as lifestyle changes, therapy, and medication – that help women control depression and enjoy their growing families.

Of course, depression also impacts women who aren’t pregnant. Because of the open, close nature of our relationship with our patients, ob-gyns have a unique role to play in identifying depression in the women we treat. That’s why routine mental health screening is an important part of the well-woman visit.