How HRT can keep men's bone young - and stop mood swings

Twice a year, Bernard Collen has a pellet implanted under his skin, and for the next six months it secretes testosterone designed to keep his bones healthy, his memory sharp and calm his irritability and mood swings.

Bernard, a 55-year old business analyst, is one of a growing number of men in Britain who are on male hormone replacement therapy.

Research increasingly shows that testosterone replacement therapy, or TRT, can protect men's bones from osteoporosis just as the female hormone oestrogen in HRT offers some protection from the bone-thinning disease for women.

TRT is also being used to help ease other symptoms of ageing, including tiredness, irritability and the effects of stress. There are suggestions that it may have a protective effect against heart disease and dementia, too.

Although osteoporosis has long been seen as a degenerative condition that affects only women - as a consequence of hormonal changes triggered by the menopause - new research shows that men are increasingly suffering.

A conference of specialists claimed that osteoporosis now affects one in 12 men in Britain.

A third of hip fractures occur in men, and one in six aged over 80 will have a fracture at some time. Osteoporosis in both men and women costs the NHS more than £1.7 billion a year.

Just why the disease is increasing in men is not clear. One theory is that it is as a result of men living longer; another is that health expectations are now higher, so men are more likely to seek help.

Yet another theory is that the increase is due in part to the decline in jobs involving manual labour, because regular exercise is strongly protective against fractures.

'It is increasingly apparent that osteoporosis occurs in men,' says Dr Roger Francis, bone specialist at the Freeman Hospital in Newcastle. 'It is no longer seen by doctors as a disease solely of women.'

Osteoporosis occurs when the biological processes that clear away old bone are faster than those that make new bone. The result is that the holes in the honeycomb structure of the bone get bigger, making it more prone to breaking.

The sex hormones, oestrogen and testosterone, play a key role in the bone-forming process, and both decline with age.

In women, the decline is rapid as a result of the ovarian changes at menopause, but in men there is a much slower and less noticeable reduction in testosterone production.

By the age of 50, a man's testosterone level may be as low as a third of the level he had in his early 20s.

Some men may experience no apparent ill-effects from this decline, while others will have severe symptoms.

Reduced testosterone production can result not only in osteoporosis, but also a drop in muscular strength, energy and libido, as well as depression, and joint and muscle pain.

There can also be an increase in upper body fat, anaemia, and some loss of mental agility.

So they can combat osteoporosis and other age-related conditions, an increasing number of men are turning to TRT, which is now available in a range of formulations, including oral capsules and pills, skin patches, injections, and slow-release, implanted pellets.

Dr Francis says: 'With older men we are aware of the potential for side- effects it may have on the prostate, in that testosterone may promote the growth of malignant cells. Because of that, we monitor this group of patients six-monthly or yearly.' Dr Malcom Carruthers, a Harley Street specialist in men's health, says the number of men who could be helped by TRT is huge.

'About 50 per cent of men in their 50s, and 60 per cent of those in their 60s could benefit,' he says. 'We want to make it more widely known and more widely available.

'We are at a turning point in the history of HRT for men. Research data is now very much in favour of testosterone treatment being effective and safe.'

For Bernard Collen, TRT has changed his life. 'It should be as essential for men as it is for women,' he says.

'The effects of low levels of testosterone really started in my 40s. At the time I was a flower buyer at Covent Garden market in London and it was a very stressful job.

'It meant getting up early in the morning, and running around in circles organising things, and I felt tired most of the time.

'I was irritable and had tremendous mood swings. It was so bad, it got to the point where my stepson thought I hated him - and my wife thought I was having an affair.

'I didn't know what was happening or what to do about it, but my wife heard about TRT and, although I was a bit suspicious, I went along and had a blood test, and the treat-ment was explained to me.

'After just two weeks I felt much calmer, and much more in control. At work I was more assertive, decision-making was easier, and it seemed to improve my memory and mental agility. Life is now completely different.'

The National Osteoporosis Society helpline: 01761 472721.