By far the most controversial hormone treatment for men today is prescription testosterone, which comes in the form of twice-monthly self-injections, prescription gels or skin patches. According to IMS Health, a pharmaceutical market research firm, sales of prescription testosterone soared to $568 million in 2006, nearly double what they were in 2002. With a host of new easier-to-use products in the pipeline, those numbers are expected to rise.

Some studies have shown that supplemental testosterone can restore sexual function and muscle strength, improve memory, prevent bone loss and possibly protect against heart disease. But supplemental testosterone has potential risks. Too much can trigger aggression and cause breast enlargement; it also thickens blood, potentially increasing the risk of stroke; and it has been shown to cause sleep apnea in some men.

Although research to date remains inconclusive, some researchers fear excess testosterone may fuel the growth of prostate cancer. That concern has prompted many—fans and critics of testosterone replacement alike—to call for more long-term health studies, such as that by the Women’s Health Initiative, which ultimately exposed the risk of hormone replacement therapy in women.

“We are lacking the Women’s Health Initiative equivalent for men and we need that,” says Dr. John Morley, head of the geriatrics division at Saint Louis University Medical School. “Everybody knows that until we do one large study that includes side effects, we won’t have a clue.”

Many practitioners say that they prescribe testosterone in cases when needed, but only after rigorous testing. Dr. Todd Dorfman, a Boulder, Colorado physician who specializes in treating male menopause, says that in some cases he can use other, more benign synthetic hormones, such as a self-injected luteinizing hormone, intended to amplify the signal from the pituitary to the testes and jumpstart the body into making its own testosterone. That way, he says, “I’m using the patient’s own physiological mechanism to get him to produce his own testosterone.”

When he does put men on testosterone supplementation, he prescribes plant-based bioidentical testosterone, which some experts believe is less disruptive to the hormone system. He also checks the patient’s Prostate Specific Antigen (PSA) levels every six months.

“The bottom line is that there are not yet any good quantifiable long-term papers about the safety of bioidentical testosterone,” cautions Dorfman. “I very specifically describe to my patients the fact that I do not know what the long-term consequences will be.

“Their typical answer? They are willing to take the risk.”

Primary Sources: Natural Solutions: Vibrant Health, Balanced Living; Alternative Medicine; InnoVision Health Media