"One of the most common complaints or questions that middle aged men ask about is a perceived lack of energy and sex drive," noted Huntington pulmonologist Ernest Vomero, MD. Just as women experience menopause as their estrogen levels decline, men also experience a natural decline in their production of testosterone as they age.

According to James Romanelli, MD, Chief of Surgery, "More and more men are questioning their declining energy levels and turning to the Internet and health-related publications for answers."

"Unfortunately, much of this information is commercially driven, and often plays upon men's basic insecurities. Generally, the articles promote specific products which promise unrealistic results," stated Lajpat Gandhi, MD, Chief of Psychiatry.

Barry Schuvall, MD, attending endocrinologist, confirmed that, "Testosterone levels typically begin to decline in the early 40s, and may go down as much as one percent each year. While intense research has been done on the effects of estrogen decline in women, there has been little study of the effects of diminishing testosterone levels in men."

"This decline is most noticeable in men in their mid-50s to early 60s, with 60% of men in this age range showing a decrease in sex drive, loss of muscle mass, and lower overall feelings of vitality and energy," added Dr. Schuvall's associate, Gary Trager, MD. "It is important to note that as with all medical conditions, this decline varies widely among individual men. There are many who sustain testosterone levels which support sexual activity into their 90s."

Urologists Kip Bodi, MD, and Nathan Newman, MD, emphasized that there is a difference between "andropause," a psychological condition, and "testosterone deficiency," a physical condition.

"The difficulty is that these two conditions can coexist, making diagnosis and treatment more challenging," noted internist Anthony Antonucci, MD.

"Andropause comes with the realization that the aging process is taking effect, which in many men occurs when a physical decline is first noted, or it becomes more difficult to perform tasks which were once taken for granted," said internist Richard Boughal, MD. "Sex drive is the most obvious and talked about manifestation of this, but in reality decreased muscle mass and a decline in physical endurance and stamina are equally troubling to men."

Dr. Boughal noted that as long as serum testosterone levels are normal, reassurance and education regarding this problem are often the best remedy.

"There is a wide range of what is considered to be a 'normal' testosterone level," said internist John Wisnieski, MD. "While it is common to find levels in the low range of normal, it is uncommon to find levels below the acceptable range." Still, Dr. Wisnieski recommends obtaining a serum testosterone level prior to beginning any type of supplementation.

What is the best form of supplementation? This will be the topic of next month's Male Call column.