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To assure these results weren’t artificial or due to an incorrect sample group, possible problems with the study design were ruled out. The investigators considered that some environmental exposure might affect testosterone concentrations, such as Agent Orange in Vietnam veterans. If this is present in younger generations, it would reduce the cross-sectional difference, since the younger men would be hormonally handicapped by the toxin(s). If a toxin is present in older generations, it would exaggerate the cross-sectional difference, as they would appear to be aging more rapidly hormonally. No such toxin was identified in the study.1
So, even after making every reasonable attempt to account for the measured declines, no explanation could be determined to account for the age-matched decline in testosterone concentration. In fact, the authors noted it’s possible that the calculated longitudinal and age-matched declines are low estimates due to survivor bias (meaning that the frail and sick died before reaching the second and third time periods, which would have included more low testosterone values in the later groups).1
Losing Your Balls?
In fact, a frightening conclusion was reached by the authors. The results indicated that one or several unidentified causes are present and evolving, which resulted in this unanticipated age-matched decline in the American male population.1 They project that if the trend is real and continues, the prevalence of hypogonadism (and its attendant health consequences) will grow in excess of forecast. Considering the impact of this information on individuals and society, it makes the guidelines of the Endocrine Society even less practical in that they recommend against screening for low testosterone in men.12 Failing to provide for the diagnosis and optimal treatment of hypogonadism reflects an underlying bias in medicine and public policy. This condition may be a significant factor in the morbidity and mortality of American men, yet it’s being purposefully neglected. If doctors and politicians forbade the diagnosis and treatment of menopause, the uproar and political backlash would be extremely formidable. Yet, American men have meekly rolled over and allowed policies out of their favor to exist without voicing a single argument.
Perhaps the men of America are losing their balls and allowing this to happen. It’s time for a re-evaluation of public policy. The current political environment is oppressive in regard to testosterone or quality-of-life treatment for men. It’s time for men to take action. In his 1951 poem, “Do Not Go Gentle Into That Good Night,” Welsh poet Dylan Thomas penned: Do not go gentle into that good night,/ Old age should burn and rave at close of day;/Rage, rage against the dying of the light.13
References:
1. Travison T, Araujo AB, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrin Metab, 2006;Epub:doi:10.1210/jc.2006-1375.
2. Morales A, Heaton JPW, et al. Andropause: a misnomer for a true clinical entity. J Urol, 2000;163:705-12.
3. Shores MM, Sloan KL, et al. Increased incidence of diagnosed depressive illness in hypogonadal older men. Arch Gen Psychiatry, 2004;61:162-7.
4. Rosano GM, Sheiban I, et al. Low testosterone levels are associated with coronary artery disease in male patients with angina. Int J Impot Res, 2006 Aug 31;Epub ahead of print: doi: 10.1038/sj.ijir.3901504.
5. Urban RJ, Bodenburg YH, et al. Testosterone administration to elderly men increases skeletal muscle strength and protein synthesis. Am J Physiol, 1995;269:E820-6.
6. Dupree K, Dobs A. Osteopenia and male hypogonadism. Rev Urol, 2004;6 Suppl 6:S30-4.
7. Buvat J, Bou Jaoude G. Significance of hypogonadism in erectile dysfunction. World J Urol, 2006 Nov 3;Epub ahead of print:doi:10.1007/s00345-006-0131-x.
8. Field AE, Colditz GA, et al. The relation of smoking, age, relative weight, and dietary intake to serum adrenal steroids, sex hormones, and sex hormone-binding globulin in middle-aged men. J Clin Endocrinol Metab, 1994;79:1310-6.
9. Isidori AM, Lenzi A. Risk factors for androgen decline in older males: lifestyle, chronic diseases and drugs. J Endocrinol Invest, 2005;28:14-22.
10. Ponholzer A, Plas E, et al. Relationship between testosterone serum levels and lifestyle in aging men. Aging Male, 2005;8:190-3.
11. Vermeulen A, Kaufman JM, et al. Influence of some biological indexes on sex hormone-binding globulin and androgen levels in aging or obese males. J Clin Endocrinol Metab, 1996;81:1821-6.
12. Bhasin S, Cunningham GR, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2006;91:1995-2010.
13. Thomas D. Do not go gentle into that good night. In Country Sleep and Other Poems. New Directions, New York, 1952.
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Research and Review 
