Journal of Sexual & Reproductive Medicine

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*Corresponding Author:
Jack Barkin
Humber River Regional Hospital and The Male Health Center, Toronto, Ontario

Fifteen years ago, the concept of hormone replacement therapy (HRT) for women was greeted with much skepticism and resistance. Today, it is almost considered to be malpractice not to prescribe HRT to women experiencing menopause. Studies have shown that more highly educated and better informed women request and accept HRT.

Are men different from women? In certain ways they are! Hormone deficiency occurs in all men as they age. The difference is that, in women, the cessation of hormonal production is both abrupt and complete. As Archie Bunker said to Edith when she was going through menopause: “So change already, time is up!!”

In men, the decrease in hormone production occurs very gradually but progressively, starting at about age 45 years. As well, the production rate never declines to zero. It is a slow and gradual fall-off. There is a decrease in total, free and bioavailable testosterone, and a concomitant rise in the sex hormonebinding globulin (SHBG). SHBG has a higher affinity for testosterone than estrogens. As a consequence, in addition to a decrease in the production of testosterone, whatever is produced is mostly bound up in the SHBG (and not available to tissues), resulting in a change in the normal testosterone to estrogen ratio, which can also cause negative effects.