'The men’s health breakthrough of the 20th Century'

Dr Malcolm Carruthers writes:  Just over 75 years ago, within 4 months of each other, 3 groups from Holland, Germany and Switzerland succeeded between them in isolating, characterising and then synthesising the male hormone, testosterone.  Within a couple of years, round about the time I was born, it began to be used clinically, to relieve the characteristic symptoms of the andropause, together with heart and circulatory diseases, and diabetes as well.  I would like to give you a sense of the ups and downs of testosterone treatment in my life-time and why it may finally be accepted for its important role in both preventive medicine and treatment.

In the first few years, testosterone treatment was available as short-acting injections, which had to be given three times a week, as long-acting pellet implants of fused crystals of testosterone , and unfortunately as an oral preparation, toxic to the liver, called methyl testosterone, only taken off the market ten years ago in the USA.  Even with this limited range of preparations, testosterone treatment became quite popular in the States, but never really caught on in the UK.  

Where did things go wrong?

World War II gave us other things to think about than treatment with hormone preparations manufactured in Germany, and post-war it was back to basic medicine.  When I qualified in 1960, and went into general practice, there was only oral methyl testosterone available for men with reduced libido and the NHS didn’t encourage prescription of that.  About that time medicine became very ‘scientific’, busy measuring things in blood, and in fact if you couldn’t measure it, it didn’t exist or was psychological.  At that time I left the bedside for the laboratory bench, to train as a chemical pathologist.

Though I ended up working as a consultant in a department of steroid endocrinology at St Mary’s Hospital in Paddington, I did my MD degree on stress, tension and heart disease, measuring adrenaline and nor-adrenaline in the blood of people in a wide variety of stressful situations.  

Then in 1977 testosterone crossed my medical horizon in the form of a Danish doctor, Jens Moller who, against considerable opposition from his medical colleagues who thought it ‘hormonal humbug’, was giving high dosage testosterone injections to patients with serious circulatory problems in the legs.

What seriously annoyed his colleagues was that when they had done all the extensive arterial plumbing they could, and the toes and even whole limbs were going gangrenous and ripe for amputation, the patients would go to Dr Moller’s private clinic in the centre of Copenhagen, and get testosterone injections.  This converted the limbs from painful, cold, blue extremities to painless and pink, and even skin ulcers and gangrene healed within a few weeks or months.  This was inexplicable in ‘scientific medical terms’ because it couldn’t be recanalising furred up arteries could it?  Recently it has been shown that the testosterone was opening up the smaller blood vessels to by-pass the obstruction, as well as causing favourable changes in metabolism, especially in diabetics.

I revisited his clinic in Copenhagen several times, and there was no denying the spectacular results he was getting with testosterone injections in saving limbs.  You didn’t need double blind placebo controlled trials to assess the results.  If you did a toe count and it remained stable for months and even years after the surgeons had decided that amputation was the only course of treatment, you were witnessing a major effect.

This interested a journalist on the Sunday Times, who wrote an article on the subject which caught the eye of a man in his mid-thirties awaiting amputation of both legs after failure of arterial operations on them.  I went to see him in hospital, and thought there was chance he might benefit from treatment.  Though nervous about the effects of this unconventional treatment, his consultant vascular surgeon gave permission for a trial of treatment.  Within a week the legs were comfortable, pink rather than blue, and the patient was running up and down the ward rather than being bed-bound.  What is really interesting is why the patient still has both legs, and until a couple of years ago was skiing and teaching tai-chi.  However it seems no doctors are interested in such cases that buck the trend.

This experience encouraged me to leave the laboratory bench and return to the bed-side in private practice about 30 years ago.   Rather than circulatory problems, the patients who came to see me had symptoms of testosterone deficiency best described as male menopause or andropause, exactly as described by American doctors at the beginning of the 1940s.  

Testosterone treatment by pills, pellets or skin gels promptly relieved the characteristic symptoms of loss of energy, drive and libido, depression, irritability, night sweats and joint pains. This was most gratifying for doctor and patients alike.

Medical colleagues in general, especially endocrinologists were much more sceptical, and for many years I had silly debates on radio, television and in the press on was there a ‘male menopause’ and was this ‘monkey gland’ treatment  just  an expensive placebo  sold to  men looking for ‘rejuvenation’.

This was especially as the testosterone levels were often within the so-called laboratory normal range before treatment.  Only later could I show that the laboratory ranges were variable and inaccurate, and the condition, like diabetes, was due to resistance to testosterone rather than an absolute lack of it.  This is a game-changer, as it justifies going much more on symptoms and their relief, rather than arbitrary laboratory normal ranges.  This theory is only gradually gaining acceptance and probably needs another 5-10 years persistent pressure before it is accepted.

What is really causing testosterone treatment to be taken much more seriously, and helping it to become part of mainstream medicine, is the evidence published over the last 5-10 years that it can help control diabetes, reduce obesity, control heart disease symptoms, treat osteoporosis and even possibly benefit early Alzheimer’s Disease and Parkinsonism.

Also because of falling testosterone levels seen in many populations world-wide, symptoms of deficiency of this key hormone and conditions related to it are on the increase.  I hope to be able to continue to bring you the good news on the rise and rise of testosterone treatment and the successful conclusion of a life-time of its use in medicine.  But it’s only been available for 75 years, so it’s early days yet – Give it time!

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