Fact or fiction?
Changes occur within everyone’s body as they get older. While the hormonal changes that occur in women in middle age are well-known, there is frequent mention today of a condition in men similarly described as “male menopause.”
It may also be known as late-onset hypogonadism. The National Institutes of Health describe female menopause as “the cessation of menses caused by the ageassociated decline in gonadal hormone secretion in women.”
The NIH recognizes that although men do not menstruate, they do have age-associated decline in hormone secretions relating to the male sexual organs. Nonetheless, the inaccuracy of the term may cause confusion.
NIH guidelines indicate a diagnosis of low testosterone when levels fall below 300 nanograms per deciliter. Unlike menopause, in which women experience a drastic decrease of estrogen at a certain age, men’s testosterone decreases slowly over time; therefore, the NIH refers to use of the term “male menopause” as inappropriate.
“As men age they will go through hormonal changes. This includes lower testosterone level which has been linked to [high blood pressure] and rising cholesterol level,” Dr. Loren Smith, a board-certified urologist at Willis-Knighton Pierremont, said. “They may experience some muscle weakness and increase body fat. Gynecomastia or breast tissue may form, and men can become depressed. However, these may or may not be directly related to lower testosterone levels.
“They may also experience depression, moodiness, decreased libido, tiredness, lack of energy. There is ongoing research looking at the association between testosterone replacement and potential benefits relative to heart attack and stroke risk, lowering cholesterol and improving blood vessel wall thickness. There is more we have to learn about testosterone’s specific effects on the body as a whole.”
Smith said, “The idea of a male version of menopause or what some would call andropause or ‘manopause,’ is not clear. We know that testosterone is responsible for many of the traits we consider to be manly. These include libido or sexual desire, typical male hair patterns, muscle strength, stamina and energy levels among others.
“We also know that as men age their average testosterone production declines. At the same time, men find that they slow down, have decreased libido, experience decreased energy level, and increasing tiredness and muscular weakness. They often just don’t feel like themselves.
“What we don’t know is to what degree declining testosterone levels (low “T”) are truly responsible for these symptoms. Depression, poor diet, lack of sleep and stress are just a few examples of other potential causes. We are subjected to a media blitz of advertising essentially telling men that low T is likely the cause, and they owe it to themselves and their partners to get the lab drawn and start replacing that “T.” As a result, we have seen an incredibly rapid rise in the number of men seeking and starting hormone replacement.
“So is there really a male version of menopause? There are certainly changes that take place, but they may be more subtle than those experienced in female menopause.”
Smith said, “Symptomatic men with a low testosterone level are often treated with testosterone replacement. This can be in the form of a topical cream or gel, injection or nasal spray and may be via a brandname drug or compounded formulation.
Depression has many causes. Some men do not require testosterone replacement and simply need antidepressants instead. The opposite can also be true of some men receiving antidepressants when they really need hormone replacement. Some men require both testosterone and antidepressants. Additionally, there are other metabolic and hormonal diseases which need to addressed and potentially treated separately.”
Smith said, “Any man seeking treatment for andropause must ensure that testosterone replacement is the right treatment option to control his symptoms. We know some of the side effects of short-term use to include increasing red blood cell counts and increased incidence of clotting. There has been a great deal of media hype about increased risk of heart attack and stroke lately. This is based largely on a couple of recently published articles, which, while interesting, have some significant flaws.
“Other articles which suggest no increase risk have not received any recognition in the mainstream media, simply showing the media’s bias for a juicy story, not necessarily providing accurate and unbiased information. There are a number of ongoing studies which, hopefully, will better answer the question of both short- and longerterm risk associated with testosterone replacement. It is imperative that if men believe they have a low testosterone level, they seek a physician who will perform a good and thorough evaluation prior to prescribing the medication.”
