So cling to me, like I must cling to truth
Or like, when we are old, we cling to youth.

      When youth migrates, it takes with it some of our powers and passions leaving us weaknesses and longings instead.  Intuitively, we deny age its dues, hold on to fleeing youth as if it were ours to keep, and refuse to learn the evident lessons of nature.  During this stage of stubborn resistance, and before we capitulate to life’s irrevocable verdicts, we search for youth-saving potions.  Of the myriad purported remedies (spiritual, mythical, traditional, or medical) the only science-sanctioned treatment is Hormone Replacement Therapy (HRT).
      When women’s estrogen production declines, we call it Menopause and when men’s testosterone production declines, we call it Andropause.  Both conditions are treatable but to treat or not to treat remains the proverbial question.  Fortunately, enough scientific evidence has been accrued to provide us with tangible answers.
      By Menopause I mean the natural or the surgical decline of estrogen production because the two conditions are similarly treated.  If a woman loses her ovaries to surgery or to age, she will become estrogen deficient.  But estrogen deficiency in itself does not justify initiating HRT.  The symptoms resulting from estrogen deficiency must disrupt life’s quality to such a degree so as to justify such treatment.
      The diagnosis of Menopause is entirely clinical and does not require supporting laboratory measurements.  This is because treatment is only given to reduce symptoms and not to treat laboratory levels.  A woman who has low hormone levels but no symptoms should not be treated.  Similarly, a woman who has severe symptoms in the face of normal hormone levels should be given a therapeutic trial and, if she responds, should be maintained on HRT.  Therefore, measuring hormone blood levels and designing or compounding hormones based on such levels is anti-scientific and has been admonished by the American College of Gynecology.  Salivary hormone levels have been shown to be unreliable and should not be done.  Nevertheless, these anti-scientific practices of measuring blood or salivary hormone levels and designing hormone therapies based on the obtained results still go on mainly because they provide lucritive profits to its practitioners.
      Menopausal symptoms are well known: hot flushes, sudden sweats, genital dryness, painful intercourse, reduced sexual desire, decreased sexual pleasure, mood swings, thinning of hair, nails, skin and bone, and weight gain around the waist.  If these symptoms are uncomfortable enough to be life disruptive, then treatment is justifiable.
      Treatment in a woman who still has her uterus requires estrogen plus progesterone.  The estrogen is what helps the symptoms but the progesterone prevents cancer of the uterus, which can be incited by unopposed estrogen therapy.  But if the woman no longer has a uterus, then estrogen alone is the choice treatment.  Giving progesterone to women who do not have a uterous is wrong and causes much more harm than benefit.
      Side effects of HRT, though uncommon, are not benign and include lung cancer, breast cancer, strokes, heart attacks, and blood clots.  Hence, the menopausal disruption to life’s quality must be severe enough to justify these serious side effects that are associated with hormone replacement therapy.
      The duration of HRT should not exceed the duration of uncomfortable symptoms.  Consequently, it is wise to periodically taper the HRT to find out if it is still needed.  HRT is not age dependant and the decisions on when to start and when to stop rest solely on the severity of symptoms and on good clinical judgment.
      Unlike Menopause, where laboratory support is not needed for decision making, measuring serum testosterone is essential for the diagnosis of Andropause because male symptoms, although quite similar to women’s, are not as specific.  Testosterone, which also has serious side effects, should not be used as an anti-aging drug.  Like estrogen and progesterone, it is only justified when the benefits outweigh the harms.  In men, this means that the symptoms are severe, that the testosterone level is low, and that treating with testosterone improves life’s quality.