Testosterone

Abstract

This quotation from Shakespeare beautifully describes the signs and symptoms of male hypogonadism. Despite the clear similarities between the effects seen in young men with low testosterone levels and the major changes reported in older males, there has been a reluctance to pursue hormonal replacement therapy in the male. Why is this the case? Although there are clearly many contributory reasons, it seems that the major reason was, until recently, the complete male dominance of the medical profession. Males have had little problem perceiving females, who, as the “other” sex, went through a hormonal change that diminished them as reproductively useful individuals. On the other hand, the very essence of maleness is their virility. The concept that males, too, may have a waning of their sex hormones with age reaches into the deepest taboos of the male psyche. Their macho image was seriously threatened by the hints of this male “imperfection.” It is for this reason that, in the area of sex hormones, we know far more about their effects in females than in males. This stands in stark contrast to most other areas of medicine, in which women have been essentially ignored until recently.

“The seventh age drifts into the lean and slippered pantaloon, His youthful hose well saved, a world too wide For his shrunk shrank and his manly voice Turning again towards childish treble pipes And whistles in his song”

William Shakespeare—As You Like It