In 1994, following Chein’s advice, he started injecting himself with human growth hormone, the substance that drives bone and muscle development in children. He claims the results were “almost instantaneous.” First came a general sense of well-being. Then, within weeks, his skin grew more supple, his hair more lustrous and his upper body leaner and more chiseled. Not one to settle for halfway measures, Fortner added the purported youth preservers melatonin and DHEA to his daily hormone cocktail, and threw in some testosterone for virility. Awash in all these juices, he says he discovered new reserves of patience and energy, and became a sexual iron man. “My wife would like a word with you,” he kids his guru during on-air interviews, “and that word is stop.”
Few men are as maniacal as Ron Fortner is about staying young. (Despite all the hormones, he recently got himself a face-lift and is now contemplating liposuction and hair implants.) But he’s at the vanguard of a nascent movement to reshape American manhood. Some 19 million male baby boomers will turn 50 over the coming decade, and many are sensing a change. The writer Gail Sheehy calls it “the unspeakable passage,” a process that starts during a man’s 40s or 50s and chews away relentlessly at his strength, his sexuality and his general sense of contentment. Some medical practitioners have taken to calling it “andropause” or “viropause” (the end of virility)–and, not surprisingly, they’re declaring war on it.
The new male anxiety has sparked heavy demand for various vanity aids, from Rogaine to ab rollers (page 77), but the possibilities don’t stop there. Urologists are teaming up with venture capitalists to launch chains of free-standing impotence clinics. Pharmaceutical companies are racing to promote new erection-inducing drugs. And a handful of hormone enthusiasts are touting cocktails like Fortner’s as the breakfast of middle-aged champions. “You don’t have to go through menopause or viropause anymore,” Dr. Theresa Crenshaw writes in her recent book, “The Alchemy of Love and Lust.” “We can prevent them.” Come to think of it, says Dr. William Regelson of the Medical College of Virginia, no one has to get old at all. Aging is “not a normal life event but a disease,” he declares in his forthcoming book, “The Superhormone Promise.” By restoring the hormones we run low on after 40–he calls them superhormones–“it is possible to slow and even reverse the aging process.”
Is there really such a thing as male meno-pause? There’s no denying that men change during middle age. A typical American male loses 12 to 20 pounds of muscle between the ages of 40 and 70. He also loses 15 percent of his bone mass and nearly two inches in height. The testicles shrink slightly after 40, and sperm production falls off, though not enough to keep some 90-year-olds from fathering children. At the same time, the prostate gland starts to amass dense connective tissue that can eventually complicate both urination and ejaculation. (In his recent book, “The Clock of Ages,” Dr. John Medina says that maximum “ejaculatory distance” declines from roughly two feet in young men to just five inches in the elderly.) The penis, meanwhile, grows increasingly sluggish, as its spongelike erection chambers fill with connective tissue and its supporting arteries narrow. Some 15 percent of U.S. men are completely impotent by 70 (up from 5 percent at 40), and a third suffer at least occasional meltdowns.
None of this qualifies as menopause. A woman’s ovaries shut down entirely around age 50, causing an estrogen crash that affects everything from bone cells to brain cells. Men typically lose some testosterone as they age, but the decline is far more subtle (chart). The levels in their blood drop by about 1 percent a year after 40, yielding a 30 percent decline by age 70. Over the same period, a growing proportion of circulating testosterone is neutralized by a protein called SHBG. But most 70-year-olds’ testosterone profiles stay within the wide range considered normal for younger men.
Could these gradual changes help explain the frailties men suffer as they age? And could testosterone-replacement therapy help forestall them? Where impotence is concerned, don’t count on it. During the late 1980s, researchers examined some 1,700 Boston-area men, age 40 to 70, and found that older men’s impotence was almost always linked to vascular conditions. The survey, known as the Massachusetts Male Aging Study (MMAS), showed that heart disease, hypertension and diabetes all fostered erectile trouble. So did smoking and alcoholism. But the researchers found no relationship between impotence and testosterone.
When you get beyond impotence, the role of hormones is harder to dismiss. Testosterone plays a clear role in kindling sexual desire in both sexes (that’s why California is considering mandatory testosterone-reducing therapy for convicted sex offenders). The hormone is also responsible for men’s secondary sexual characteristics–the beard, muscles, thick skin and aggressive driving habits. Young men with abnormally low testosterone levels, a condition known as hypogonadism, often suffer a loss of bone, muscle, energy and libido. Testosterone therapy can reverse their symptoms, and every athlete knows it can boost a healthy person’s size, strength and endurance (NEWSWEEK, July 22). So it’s plausible, if unproven, that testosterone supplements could reduce the effects of aging. “We give eyeglasses to people as they age to maintain visual acuity,” says Dr. Norm Mazer of TheraTech, the company that developed the recently approved Androderm testosterone patch. “Why not give them testosterone to retain muscle strength and prevent osteoporosis?”
Testosterone is still used mainly to treat acute deficiencies; replacement therapy is not a common practice, just an intriguing idea with a long history. In 1889 a 72-year-old French scientist named Charles Brown-Sequard started an international rage by announcing that he had rejuvenated himself with a “liquid extract of fresh guinea pig and dog testicles.” His claims of increased strength and alertness, better digestion and a longer urinary arc couldn’t be replicated. But scientists are now taking a closer look at testosterone’s effects on aging, and the early results are encouraging.
In a 1992 study, Dr. Joyce Tenover of the Emory University Medical School placed 13 elderly men on a six-month regimen that included three months of testosterone and three months of placebo. While taking the hormone, the men gained muscle mass and excreted less bone mineral. Their cholesterol levels fell and their moods and libidos perked up. Other small studies have shown similar results, and none has turned up significant side effects. But there are good reasons to be wary. At the high doses some muscle builders use, the hormone can cause breast development and sterility (indeed, high-dose testosterone is under study as a male contraceptive). Even the smaller doses used for replacement therapy could fuel the growth of prostate tumors, which are common in older men. And because testosterone speeds the production of red cells, it could thicken the blood, thus raising the risk of stroke.
Despite the possible hazards, a handful of doctors and patients are forging ahead with treatment. Dr. Edward Klaiber, an endocrinologist at the Worcester Foundation for Biomedical Research in Shrewsbury, Mass., has used testosterone to treat dozens of aging men’s impotence problems. He says 80 percent of his patients have been pleased. One of them is Robert, a 56-year-old consultant who wore a scrotal patch for two and a half years and now uses the new Androderm system, a pair of patches that work for 24 hours when applied to any part of the body. Since raising his testosterone level from the bottom to the top of the normal range, Robert has seen his beard thicken, his body odor worsen and his libido explode. “Whether it’s mental or physical, you start feeling older when you can’t do physical things like you could,” he says. “Sexually, I’m more comfortable because I know I’m dependable.” His only complaint is that he’s always covered with little rings of glue that won’t come off without a heavy-duty astringent.
Patch makers would no doubt love to see 19 million boomers scrubbing their torsos with glue remover, but cost and convenience are still obstacles. Testosterone requires a prescription, and the patch costs about $100 a month. Right now, a likelier tonic for the masses is DHEA (dehydroepiandrosterone), a hormone that many over-40 fitness buffs are already snatching up in health-food stores for $5 to $10 a month (page 74). Both males and females produce DHEA in their adrenal glands, males at a slightly higher level. Like testosterone, it floods our bodies during early adulthood but dwindles as we age. And because it helps fuel the production of sex hormones–particularly testosterone–it can have similar (though milder) effects. Proponents believe that maintaining youthful DHEA levels can improve mood, memory, energy and libido, while preserving lean body mass and countering the effects of stress hormones.
Like many DHEA users, Terry Patten has always worked hard at staying healthy. He eats well, exercises, even practices meditation and yoga. But when the Marin County, Calif., entrepreneur turned 43 a few years ago, he felt his energy waning. “It seemed like my reserve tanks were depleted,” he says. DHEA was a fairly obscure chemical at the time. The FDA had officially discouraged over-the-counter sales in 1985, but pharmacies were free to mix DHEA for prescription orders. So, with his doctor’s help, Patten got a jar of 50-milligram capsules and started taking one every morning. “I suddenly felt I had an extra something,” he says, “a sharpening of mental acuity and a mood boost as well.”
Today, due to a change in federal rules, Patten and others are selling the stuff as a nutritional supplement, and enthusiasts see the beginnings of a craze. At least three major publishing houses are now promoting good-news books (Dr. Ray Saheliann’s “DHEA: A Practical Guide” has been out for several months; Dr. Stephen Cherniske’s “DHEA Breakthrough” and Regelson’s “The Superhormone Promise” will reach stores this fall). And DHEA sales are already surging. “DHEA will be bigger than melatonin,” predicts John Morgenthaler, the founder of California-based Life Enhancement Products, which sells both. Morgenthaler started stocking DHEA just a year ago, but it now accounts for 40 to 50 percent of his sales. David Blanco of the LifeLink supplement company in Grover Beach, Calif., is riding the same wave. In one recent month, his company bought 200 kilos of DHEA powder–enough to make 2 million capsules. “It’s a tsunami!” he says.
Publishers and supplement makers aren’t the only ones excited about DHEA. In test-tube and animal studies, scientists have found preliminary evidence that the hormone can protect and strengthen the immune system (by holding stress hormones in check), forestall diabetes (by normalizing the production of insulin), enhance learning and memory (by stimulating brain-cell development) and help control obesity (by inhibiting fat formation). Researchers are only beginning to pin down DHEA’s effects in humans. In small studies, people taking moderate doses have reported many benefits and few side effects (women taking excessive doses sometimes develop acne and facial hair). But as with testosterone, the long-term risks and rewards remain uncertain.
That’s doubly true of human growth hormone (hGH), yet the most avid hormone replacers wouldn’t start the week without it. Until recently, physicians harvested growth hormone from cadavers’ pituitary glands and used it to treat dwarfism in children. But biotech companies started synthesizing the molecule in the late 1980s, and in the early 1990s researchers started investigating its potential as a rejuvenator. Buoyed by small studies in which elderly users experienced the usual trinity of age-reversing benefits–less fat, more lean mass, more energy–doctors like Edmund Chein started prescribing it to patients such as Ron Fortner. Chein, the Palm Springs “life extender,” claims he has used growth hormone to help hundreds of men through viropause.
But don’t call your doctor for a prescription just yet. A year’s supply of hGH costs $10,000 to $15,000, and the possible side effects are daunting. It can cause severe fluid retention (possibly triggering heart failure), enlarge the organs and bones (causing joint pain and carpal tunnel syndrome) and worsen diabetes. Dr. Stanley Slater, director of hormone research at the National Institute on Aging (NIA), notes that lowering a person’s dose usually quells any side effects. Unfortunately, the benefits of low doses are unclear. The NIA is now sponsoring several large studies that could help answer that question. And drug companies are working to develop gentle, affordable treatments that would stimulate the body’s own secretion of hGH.
If hormone replacement fulfills its promise, getting old should soon be more fun than ever before. In Regelson’s fantasy, men will spend their 80s skiing the Alps and flying hot-air balloons over the Sahara. They’ll still have healthy partners and libido to spare. The catch, according to studies like the MMAS, is that nearly half of those Dorian Grays will have a problem that hormones alone can’t fix. Roughly 25 million American men already suffer some degree of impotence. Fortunately the folks at The Upjohn Co., now officially Pharmacia & Upjohn, are ready to help. In the past year, Upjohn has run ads in about 60 consumer magazines, including NEWSWEEK, announcing that “almost every man can successfully overcome impotence” as long as he visits one of the specialists the company can recommend.
Upjohn is selling the world’s first commercial erection injection. Instead of activating a spring-loaded implant or applying a vacuum pump, the user injects a fifth of a teaspoon of prescription medication into the side of his penis. The thought of a penile injection gives most men the creeps, but as the British physiologist G. S. Brindley demonstrated in 1983, it can be fairly painless and highly effective. In a now famous address to the American Urological Association, Brindley argued that chemical relaxants could open the vessels feeding the penis’s inner chambers, letting in blood that would trigger an involuntary erection. At the end of his talk, he announced that he had injected himself just before taking the podium to show that the technique would work even in the most forbidding cir- cumstances. Then he lowered his pants and bared the living proof. His colleagues crowded onto the stage, suspicious that he was wielding a novelty-store prosthesis. But it was all Brindley.
The Upjohn system uses a vessel relaxer called prostaglandin E1, but urologists have identified at least two other drugs (papaverine and phentolamine) that are equally effective for inducing hourlong erections. In his urology clinic at the Boston University Medical Center, Dr. Irwin Goldstein regularly prescribes all three. Goldstein studied engineering as an undergraduate, and he spends his days teaching patients that their secret torments are just mechanical snafus. “The penis is a column that has to prevent collapse when it penetrates,” he says. “It’s all hydraulics!” He illustrates the point by hooking patients to pumps and manipulating their penile angles with the turn of a dial. When his tests show that their erection chambers aren’t working properly, he teaches them to inject themselves. “They can turn the whole event into foreplay,” he says. “He’ll say, “Honey, it’s time for the needle,’ and she’ll do her foreplay thing. It’s not what you’d like it to be, but it’s a hell of a lot better than nothing.”
Not everyone agrees. Steve, a retired cop in his mid-50s, had suffered erectile failures for several years when he visited Goldstein’s clinic recently. Feeling humiliated, he had started rejecting his wife’s bids for intimacy and blaming her for the ill feelings that followed. “It was a manhood- type thing,” he says. After putting Steve through a simple injection test, Goldstein explained that a fatty diet may have narrowed the patient’s penile arteries, and that a home-injection kit could restore some intimacy to his marriage. But Steve wasn’t ready to go that far. “It’s just not me,” he says. “It’s a manhood thing.”
Within a few years, guys like Steve will have more options. A Menlo Park, Calif., company called VIVUS is awaiting FDA approval on a system called MUSE, which pumps soft, medicated pellets into the urethra. Other companies, including the drug giant Pfizer, are scrambling to license what could be the ultimate erection aid: a pill you take an hour before sex. The Pfizer remedy, Viagra, increases blood flow to the penis, enhancing a man’s normal response to stimulation. In early studies it has helped up to 90 percent of the patients taking it. Even Steve says he’d like to give it a try.
So add another option to the menu, guys. As the population of aging males grows, the virility-preservation movement is sure to grow with it. “Basically, it’s a marketing issue,” says epidemiologist John McKinlay, director of the New England Research Institute and head of the MMAS. “The pharmaceutical industry is going to ride this demographic curve all the way to the bank.” The irony, of course, is that much of what the new drugs and hormones promise is readily attainable without treatment. Exercise and a healthful diet can build bones and muscles while reducing fat, controlling weight and increasing strength, energy, mood, sleep and libido. Exercise may even bolster production of the “youth” hormones. Drs. Mitchell Harman and Marc Blackman of Johns Hopkins are now conducting a large study to see whether growth hormone and testosterone can mimic the effects of exercise. Even if they can, no one expects them to take its place. The sad truth is that staying manly takes more than money. It takes work.
Enthusiasts believe hormones are the ultimate antidote to aging, and they advocate “replacement therapy” for both sexes. The treatments are largely untested, but some midlife men are betting on them to preserve their youth and virtility. A sample:
Testosterone
BENEFITS CLAIMED
maintains muscle
reduces total cholesterol
increases energy and libido
RISKS
triggering or stimulating prostate tumors
reducing HDL (good) cholesterol
blocking sperm production
AVAILABILITY
Prescription-only patch, pill or injection
$50 to $100 a month
DHEA
BENEFITS CLAIMED
improves mood
increases energy and libido
counteracts stress hormones
preserves musle
strengthens immune system
prevents cancer and heart disease
RISKS
untested in longterm clinical trials
strength and purity are not regulated
AVAILABILITY
over-the-counter supplement
$5 to $10 a month
Melatonin
BENEFITS CLAIMED
improves sleep
protects cell from free-radical damage
boosts immunity
prevents cancer
RISKS
unregulated and largely untested
grogginess or mild depression
AVAILABILITY
over-the-counter supplement
$5 to $10 a month
Human growth hormone
BENEFITS CLAIMED
preserves lean body mass
preserves skin
boosts immunity
improves heart and kidney funtion
RISKS
diabetes
fluid retention
enlarging bones and internal groups
AVAILABILITY
prescription-only injection
$800 a month
