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These ads were paid for by Unimed, a division of the Belgian conglomerate Solvay. Unimed makes AndroGel, a drug that was approved by the F.D.A. two years ago, and is the fastest-growing form of testosterone-replacement therapy for men. Pills, introduced in the sixties, often caused liver damage. Intramuscular injections, particularly favored by bodybuilders and competitive athletes, produce a sharp spike of the hormone, and then a fall, and these fluctuations are often accompanied by swings in mood, libido, and energy. In the late eighties, a transdermal patch was developed, and its use is still widespread. The patch provides safer and steadier dosing, but often causes skin irritation, and sometimes falls off during exercise. AndroGel, by contrast, delivers testosterone in a colorless, drying gel that is simply rubbed on an area of the body—usually the shoulders—once a day. It has thus made testosterone available in a form that almost any man can use conveniently.
United Medical Network: Dr. Ab
raham Morgentaler
If hormone-replacement therapy for andropause becomes as common as such therapies have been for menopause—and this seems to be the ambition of some drug companies—the consequences, both medical and financial, could be dramatic. Given the popular desire to reverse human aging with a simple nostrum and the growing intimacy between commercial and clinical concerns, the trend may prove to be irresistible. The pharmaceutical industry is, of course, in the business of inventing treatments. Some people wonder whether it may help invent diseases, too.
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To be treated for andropause, you first need physicians who can confidently make the diagnosis. One of them is Dr. Abraham Morgentaler, the director of Men's Health Boston. He is forty-six years old, with thick black hair and deep-set eyes. Trained as a urologist, he specializes in male sexual dysfunction and infertility. He views testosterone deficiency in older men as a silent epidemic, and worries that, of the perhaps five million American men who suffer from it, ninety-five per cent go undiagnosed. Replacing missing testosterone, he believes, will help restore youthful muscle tone, bone strength, potency, and general vigor. He recently put an ad in the Boston Globe urging men who were experiencing "low sex drive" or "low energy" to have their testosterone level tested at his clinic. The costs of both the ad and the tests were underwritten by a Unimed educational grant.
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Men's Health Boston is in a modern brick-and-glass office building at a busy intersection in Brookline. It has a well-appointed waiting room with soft lighting and upholstered chairs; photographs of famous local athletes adorn the walls. The men who came to see Morgentaler on a recent afternoon had all been given a questionnaire provided by Unimed:
1. Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased "enjoyment of life"?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?
United Medical Network - my brain often feels foggy
Among the patients was a real-estate broker in his late fifties. He had answered "Yes" to questions 1, 2, 3, 5, 7, and 10. "I'm just exhausted by the end of the afternoon," he said, after Morgentaler gave him a physical. "And my brain often feels foggy." He likes to shoot pool, and he remarked that his game wasn't what it used to be.
"Have you noticed any change in sexual performance?" Dr. Morgentaler asked.
"Well, I'm not a kid anymore," the patient said, but he had no real complaints.
Morgentaler then showed the man the results from his blood assay. His testosterone levels were "somewhat low," Morgentaler said. "Now, if I had a magic wand and I could do anything for you, what would it be?"
"Fix the energy thing."
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