PADAMboom!!!

Testosterone (T) is not just another hormone: it is endocrinologic dynamite. Testosterone supplementation at low levels is passionately and controversially discussed among health care professionals and lay people alike, giving it a cultural, social and even a political dimension. The problem arises with decreasing levels. With an incidence of 6% in middle-aged men [1], late-onset hypogonadism (aka: PADAM = Partial Androgen Deficiency of the Aging Male) can be frequently discovered in clinical practice. Unfortunately, the relationship between serum testosterone levels and clinical symptoms is a bit hazy. It appears that a substantial proportion of men with low T lack clinical symptoms whereas a high number of men with clinical symptoms have T levels within the normal range. However, the likelihood of symptoms increases with decreasing testosterone [2]. Facing PADAM, second thoughts regarding treatment seem to be commonplace. Is replacement really necessary? Isn’t there more harm than good to it? Definite randomized controlled trials to answer these questions are lacking, so uncertainty lays the ground for speculations. Fueled by many sources, including the media, testosterone is about to become the villain of hormones. The negative connotations include fear of cancer, images of doping scandals, of humongous body builders or the money-greedy pharmaceutical industry. In February this year, the New York Times wrote: “Drug companies have shamelessly pushed the notion, to doctors and to the public, that their testosterone-boosting product can overcome a supposed disease called ‘low T,’ which is characterized by feelings of fatigue, loss of sexual drive, depressed moods, an increase in body fat and decrease in muscle strength, among other symptoms” [3]. PADAMboom!!!