I believe what an elderly leader of the medical profession once old me: ‘Three things are necessary for a happy old age -

I believe what an elderly leader of the medical profession once old me: ‘Three things are necessary for a happy old age – a set of comfortable false teeth, a good pipe and a total lack of libido’.” Perhaps a few more men should take a leaf out of his book !. Some-times the psychological effect of getting an erection from the first injection, after years of being unable to do so, is enough to cure the problem. There is no simple correlation between impotence and low androgen levels, because some men with low androgen levels have perfectly normal sex lives.”While nobody should minimise the misery caused by impotence, depression and lethargy, few doctors believe the solution to these problems is simple. After receiving the initial injection from him at his surgery, the patient learns how to inject himself.”Often,” Mr Hirsh explains, “patients do not need to continue with the injections anyway. Studies have shown that two-fifths of men over 65 who have died from other causes had cancer of the prostate. But these cancers are testosterone-dependent; if you give a man extra testosterone, it could make the cancers grow.Second, testosterone can raise fat levels in the blood. The result is that fat gets laid down in the arteries and the arteries become narrower, making blood clots and heart attacks more likely.

Dr Carruthers says he is well aware of these problems, and tackles them by doing a full medical check-up of all his patients, including three separate investigations for cancer of the prostate. “I reckon I save more men from cancer of the prostate than I cause, by picking up early cases.” In the 1,000 men he has treated over the last seven years, he has picked up four cases.But other specialists in male reproductive disorders believe there are alternative treatments to give to men suffering from lethargy, depression and erection problems in middle life, which do not have any dangerous side-effects. Mr Anthony Hirsh, consultant andrologist at Whipps Cross Hospital, Essex, and Harley Street, says: “I usually start patients off with a series of oral medicines which are not hormonal, and do not have the inherent dangers hormones can have if given long-term. These include vitamin preparations and extracts of the yohimbe tree, from west Africa, which has been shown to work in a controlled trial reported in The Lancet.”In extreme cases, where patients cannot get an erection, he also offers injections of a prostaglandin or the drug papaverine, a smooth muscle- relaxant extracted from poppies. Some men in their sixties have small, asymptomatic cancers of the prostate which, left alone, might grow so slowly that they never threaten their lives.

It is well recognised that, if a doctor gives you a pill and tells you it is going to work, it often does. This is known as the placebo effect.Moreover, the treatment has its dangers Two problems in particular stand out. I have never seen the result of a controlled clinical trial in which symptoms got better among those on synthetic testosterone, compared with those in a control group.”Dr Carruthers may believe the evidence presented to him by his patients, but to convince other doctors he would need a control group which was also being given surgical implants containing no active ingredient at all. “There is a pleasing symmetry,” he says, “which says that the menopause should exist in men and that they could be helped by hormone replacement therapy But there is no evidence for it.

Masters and Johnson suggested as long ago as 1970 that lowered levels of male hormones could be partly to blame, but they also attributed men’s reduced sexual desire to such non-hormonal causes as monotony in a long-term relationship, worry about money and jobs, the stress of going through what is probably the most competitive phase of their careers, mental and physical fatigue, and over- indulgence in food and alcohol.Unfortunately for the proponents of testosterone, or androgen replacement therapy, there is no scientific proof that it works Professor Howard Jacobs, for one, is sceptical. “It has been perfect for me,” he says.Though erectile problems in middle-aged and elderly men are common, not many doctors put the problem down solely to a drop in testosterone levels. “I went to see Dr Carruthers,” he explains, “because I was experiencing lethargy, loss of muscle strength and night sweats. The most worrying thing was that I lost the ability to get an erection.