Male Menopause

Do aging males undergo a menopause like women?

Yes, and not surprisingly men are not spared from a “menopause”. The andropause or the “male menopause” is the time in a man’s life when the hormones naturally decline. It is also a time where there is a change of life that may be expressed in terms of a career change, divorce, or reordering of life. This event brings about psychological changes as well. Like menopause, the andropause usually occurs from fifty years onwards. Some have questioned whether the male menopause is more myth than reality. In truth, there is an undeniable hormonal decline as one age, and this in turn accelerates the aging process. The decline in hormones for men is more gradual unlike in women’s menopause, which is a more abrupt event. For that reason, the andropause is sometimes termed medically as the A.D.A.M., an acronym for Androgen Decline in Aging Males.

Men can suffer from symptoms of the andropause, and they may be similar to that of menopause. Between the ages of 50 to 70, some men report symptoms such as erectile dysfunction (failure to achieve an erection), general tiredness, mood changes, night sweats and sometimes palpitations. My research reveals that most men attribute erectile dysfunction to be the most significant event of the andropause. Apart from erectile dysfunction, mood changes can take place too. Some patients of mine have complained of nervousness, irritability and even depression. Other patients undergoing andropausal changes report the feelings of wanting to be closer to family and friends. Men often focus too intently on their career, money and power in their earlier life, often neglecting family and friends. In the andropausal years, men and take on a more “maternal” role, as if transitioning to become more motherly than fatherly. They become more concerned about their friends and family, as if regretting their former attitudes. It is interesting that many patients do not sense these changes in themselves, but rather it is women that notice this and tells me that he is undergoing “the menopause”!

In andropausal men, night sweats and palpitations occur because of an overactive autonomic system in response to falling testosterone levels. It is important not to dismiss or misdiagnose physiological changes related to the andropause.

Is memory loss part of the andropause?

I believe so, as in my research, I found that the third most common reported symptom of andropause was indeed memory loss. It is not uncommon for patients who undergo the andropause to report misplacing a key or forgotten important details. Often the memory loss is so minor it does not affect everyday functioning. This memory loss has sometimes been referred to as “age related memory loss” and is not as severe as Alzheimer’s disease, (which is accompanied by loss of functioning). Memory loss in the andropausal years has been a research interest of mine. In my clinical studies, I have replaced testosterone in demented hypogonadic men (those low on testosterone) and have demonstrated improvements in their visual-spatial cognitive abilities. Although the study results have been presented at several scientific meetings, more research is needed before recommending testosterone as a possible treatment of certain dementias. Another researcher in Oregon has found similar results and he demonstrated improving cognitive functions with testosterone even in normal older men who did not have hypogonadism.

Should men see a doctor to manage their andropause?

Women often see their physicians to manage symptoms related to the menopause. In managing menopause, doctors frequently prescribe drugs such as estrogens, calcium, aspirin and biphosphonates for postmenopausal women in the hope that they decrease risk of osteoporosis, heart attacks and dementia.

However, research demonstrates that men by and large are less likely to see a doctor for any reason. Part of it is because the male psyche where a dependent role is not acceptable. Generally speaking, men tend to focus less on health and more on money, power and status. One strategy to get men to see their doctor is actually to see a understanding and well trained doctor together with their significant other. Sometimes, the doctor can get a lot more information interviewing couples together. At times, the interviews should be held separately and staggering consult times 30 minutes apart is prudent. During the interview, the doctor may assess for “hypogonadism”, which is in part the clinical basis of the andropause. Hypogonadism means low in hormones like testosterone. The doctor may check for the following in men to confirm hypogonadism:

loss of armpit and genitalia hair

shrinkage of testicle size

loss of libido and impotence

tiredness and depression

muscle weakness and bone loss

Androgens basically create “masculinity” and the loss of androgens such as testosterone leads to physical changes. Women in their post-menopausal years complain of dryness in their vagina, skin and sometimes even a lowering of the pitch of voice. The dryness in the vagina could result in dyspareunia or pain on intercourse. In men, subtle changes occur in the post-andropausal years. The once dashing looks are now exchanged for something much less eye-catching. Hardened muscle disappears and instead, flabby fat accumulates, as one gets older. This distorts the physique from an athletic “android” to one with a beer belly and little muscle. The skin also gets dry, and there is hair loss. Hair loss occurs not only in the scalp, but also in the genital area as well as in the armpit. The testes also get smaller in size. There is loss of height because of osteoporosis and the spine gets curved from wedge compression fractures. It is important to realize that testosterone can maintain bone integrity just like estrogens in women.

The reason for seeing an understanding doctor is that there is potential help available. Some of the physical and accompanying psychological changes may be treated with counseling as well as with certain hormones. Treatment for impotence or erectile dysfunction and mood changes is easily available today.

How can we cope with the changes associated with the andropause?

The andropause brings about physical and psychological changes. As the older male ages and undergoes the andropause, he has to grapple with profound changes and issues. These changes bring about stress, and if stress is not managed well, it can be very disabling and even lead to depression. In my book, “The Andropause Mystery”, I described Six Simple Strategies to combat Stress in the Andropause. I believe that these 6 simple strategies can help you manage this aging process graciously. The 6 strategies for a successful andropause is summarized below:

1. Learn to love and reward yourself and others. Much satisfaction can be obtained from not only receiving but also giving. We cannot bring our earthly wealth to the afterworld, and we should learn to reward not only ourselves but also those around us. There comes a point in life where leaving legacies behind become important.

2. Take control and organize yourself. Discipline is important even in the later part of life. In particular, learn not to abuse alcohol and quit smoking. Time management is crucial as well. It is important for instance, to prepare our wills, estate management and advance directives and that is part of organizing ourselves.

3. Exercise yourself. A combination of cardiovascular and muscle conditioning will help delay aging processes.

4. Relax and Rest yourself. The body is changing with aging and there are physiological changes occurring and that he and you should be mindful of that.

5. Feed yourselves- not quantitatively but qualitatively! It is important to eat the right kinds of food to adjust for physiological aging changes.

6. Enjoy Aging and the Andropause. Some things are inevitable, no matter what we do! It is important to be satisfied. Most of us will have to pass through this journey so let us make the best of it. May we make this journey of profound change one also of positive evolvement, and a time of rich blessings for ourselves as well as those around us, as we age graciously through the andropause!

Will the future for men’s health include hormone replacement as it is for women today?

I studied 302 men, and one of the questions are asked them was this: “if the doctor told you that your testosterone level is normal, will you still go want testosterone replacement?” Rather surprisingly, the majority of the respondents said “YES”. My rationale is that there really cannot be too much of a good thing! Perhaps men perceive hormones like testosterone differently from women. It seems to me that by and large, men want to remain virile and stay away from aging naturally. While some women have delayed the end of reproductive life by the aid of science, it is rare. However, men throughout centuries and across all cultures have taken all sorts of supplements including aphrodisiacs, secretogues, vitamins etc. in an attempt to stay virile. It is interesting that some cultures in Asia have been using the root of a plant for anti-aging purposes. Recently, scientists found that this root stimulates the body’s own testosterone production and accounted for some of the anti-aging properties.

I believe men want to be on hormonal replacement, and they need to hear from their doctors that it is safe and effective. There are insufficient large clinical trials to say that hormonal replacement is for all men. Before then, men will continue to use their anti-aging supplements in an attempt to delay their age. Doctors have a responsibility to their patients as their practice is rooted on “evidence-based medicine”. At this point, hormonal replacement for men should be considered on a case-by-case basis, depending on symptoms. Over the next decade or two, as more information is available, I do foresee that hormonal replacement will be more routine and perhaps replace some of the self-help regimens that men are experimenting with now.