Saturday's Scribe - Myth of Male Menopause

The myth of “Male Menopause”


It's bad news, fellas - after fifty, it's downhill all the way. Falling sexual drive, declining muscle strength, irritability - just some of the symptoms of the so-called 'male menopause'. But is the term a myth? What's really going on, and can testosterone supplements fix it?

Some doctors claim that the fall in testosterone levels causes the range of symptoms just listed - in a similar way to the symptoms caused by the sudden fall in female sex hormones when a woman reaches her forties or fifties. Hence the term 'male menopause'. Some men's health clinics in the major capital cities are advertising testosterone replacement treatments - given by injection, tablets or skin implants - as a 'cure'.

So-called testosterone replacement treatments are big business in the US where over the last 10 years, there's been 10-fold increase in doctors prescribing the hormone, driven by direct advertising by drug companies, men's heath clinics and by best-selling books with titles like Maximising Manhood, The Testosterone Revolution and Male Menopause.

Over the same period, there's been an increase in doctors prescribing testosterone here in Australia - a three-fold increase in tablets and a lesser increase in injections - according to a study published last month in the Medical Journal of Australia, which tracked prescribing patterns from 1991 to 2001.

Does testosterone replacement therapy work? Studies looking at the effect of testosterone supplements haven't shown any improvements in the grab bag of symptoms attributed to the 'male menopause'. A few studies have shown slight increases in muscle mass and bone density, but the results are inconsistent. There are no long-term studies that show it's safe - and testosterone is known to be a risk factor for prostate cancer - however, some men who get testosterone treatment do find there's an improvement. But this is almost always wishful thinking. They think they're getting better, but the effect is short-lived.

It is normal for men's testosterone levels to fall gradually after the age of 30 years. Unlike women, whose oestrogen levels fall rapidly when they go through menopause, men's testosterone levels fall much more gradually and over a longer period of time. Male menopause is a misleading term. Ageing does affect testosterone levels in men but the effects vary. Only men with proven androgen deficiency will benefit from appropriate treatment. Other terms used to refer to a decline in testosterone levels include andropause or viropause.

Testosterone deficiency is a condition in which a man has lower than normal levels of testosterone in his blood. In ageing males (those over 40 years of age) it is sometimes also referred to as late-onset hypogonadism, andropause or male menopause. Testosterone deficiency in ageing men is caused by a natural reduction in testosterone production as a man ages.

Andropause refers to a set of gradual physical and psychological changes that men generally go through beginning in middle age. Andropause is equivalent to the menopause that women over 45 suffer from.

What're the symptoms of andropause? Symptoms of andropause can vary from one man to the next. Symptoms of male Andropause may include lethargy or decreased energy, decreased libido or interest in sex, erectile dysfunction with loss of erections, muscle weakness and aches, inability to sleep, hot flashes, night sweats, depression, infertility and thinning of bones or bone loss. When there is less testosterone available to do its work, the testosterone target-organ response decreases, bringing about many changes. Since there is great variability in testosterone levels among healthy men, therefore not all men will experience the same changes to the same extent.

According to some experts, many men who experience these age-related symptoms are leading unhealthy lifestyles - they smoke, they drink too much alcohol, don't get enough exercise and are overweight. Also (and because of these lifestyle factors) as men get older, they fall prone to diseases like diabetes, heart disease and depression - adding to their symptoms.

There is a place for genuine testosterone deficiency. Some men - about one in 200 - do have a medical condition that causes the testes to make less than normal amounts of testosterone. The most common is Klinefelter's syndrome, a genetic disorder in which the testes don't function adequately. These men do benefit from testosterone treatment. Only if doctors suspect a medical condition like this should they prescribe testosterone, and then only a after a series of blood tests shows their testosterone is abnormally low. Treatment should be managed by a specialist endocrinologist.

Instead of worrying about their testosterone levels, men 'of a certain age' should get plenty of exercise, stop smoking and drinking too much, and see their doctors to determine if they have any underlying condition that can be treated.

So, guys, get off the couch and get active – take the kids for a walk to the park and take along the dog and a bat and ball. Start eating good meals regularly and leave that ‘cardiac diet’ of coke and hamburgers behind. Get that weight down and start fitting into some of those clothes that have been hanging in your closet ‘cos you cannot get into them anymore. Go for long walks, stop smoking, lay off the alcohol and watch your sex-life and libido turn itself around. There’s nothing wrong with you that good healthy living wont fix.