Most people know that women experience menopause, but did you know that some men go through a kind of male menopause? For men who believe they are going through the proverbial midlife crisis, some doctors and researchers say you may actually be experiencing a form of male menopause called "andropause."
Shocking as it may be to some men, male menopause, or andropause, is becoming more widely recognized and accepted by physicians for the changes many middle-aged men experience — from energy loss to depression to loss of libido to sexual dysfunction. And some clinicians are recommending that certain men experiencing these symptoms, along with a host of others such as decreased bone density and weight gain, seek hormone replacement therapy and other treatments.
"It's like puberty in reverse," Jed Diamond, a California psychotherapist and author of "Male Menopause" and the forthcoming book, "Surviving Male Menopause", says of andropause. Like puberty, the changes that andropause wreaks in aging men, Diamond says, are "hormonal, psychological, interpersonal, social, sexual and spiritual."
Andropause is characterized by a loss of testosterone — the hormone that makes men men. Most men see testosterone levels drop as they age. However, some men are impacted more than others are. Diamond says that as many as 25 million American males between ages 40 and 55 are experiencing some degree of male menopause today.
"Male andropause can be very insidious," explains Dr. Stephen Sinatra, a Manchester, Conn., cardiologist board certified in anti-aging medicine. The loss of testosterone, which can happen to men as young as 35, is gradual, with testosterone levels dropping just 1 percent to 1.5 percent annually. Unlike the precipitous loss of estrogen that women hitting menopause face, the gradual loss of testosterone may take years to exact its mark on men with a host of symptoms not unlike changes menopausal women experience.
Irritability, fatigue, depression, reduced libido and erection problems are hallmark signs of andropause. "I felt like I didn't want to move," says Cecil Dorsey of Vernon, Conn. The 68-year-old retired truck driver, who discovered via a blood test nearly four years ago that his testosterone levels dropped, said, "I just didn't want to be bothered by anything."
A Fresh View on an Old Condition
Although the first study on male andropause was published in the "Journal of the American Medical Association" in the mid-1940s, it's only recently that the U.S. medical community has taken notice of this condition, says Dr. Adrian Dobs, an endocrinologist and associate professor of medicine at the Johns Hopkins School of Medicine.
Typically, men suffering from the symptoms of andropause are treated for a specific medical condition. And therein lies the problem, Diamond maintains. For example, an andropausal male may be diagnosed with depression and prescribed an antidepressant, and both doctor and patient think the man's problem has been addressed. However, if that man has other symptoms of male menopause such as loss of libido, the antidepressant will only exaggerate that problem.
"Conventional means [of treatment] don't look at it as a pattern," Diamond says, who believes a more holistic approach is needed to address all of the symptoms of andropause. This could include conventional therapies combined with testosterone replacement therapy, psychotherapy, herbs, and diet and exercise.
Pros and Cons of Testosterone Replacement
Testosterone replacement therapy is the primary means of treating men with declining levels of testosterone, and this is still a controversial area. "What are the problems faced and can they be treated with testosterone? That's where the question lies," Dr. Dobs says.
"All men should be brought up to a certain level of testosterone," advocates Dobs, who suggests that minimum levels should be 300 nanograms per deciliter of total testosterone. The mean level for a 40-year-old is 500 nanograms, she says.
Instances where testosterone replacement therapy is advised, Dobs says, include men with clear bone density loss, which can lead to osteoporosis and decreased height, and in treating sexual dysfunction in cases where Viagra or other often prescribed remedies don't work. Another area of possible benefits of testosterone therapy may be in cases to maintain body composition and muscle — for instance, in patients fighting cancer.
But testosterone replacement therapy is "not a benign treatment," warns Dr. Michael A. Werner, a White Plains, N.Y., urologist with specialized training in male reproductive medicine and surgery and male erectile dysfunction.
Specialists say that men considering testosterone replacement therapy—whether by injection, patches, cream, gel or oral form—should get their PSA levels checked as testosterone replacement therapy could increase the risk of prostate cancer. (A PSA blood test identifies a man's risk for prostate cancer.) Other risks associated with hormone supplementation, particularly with injections, include the risk of stroke, an increase in liver toxicity and breast development. Ironically, testosterone supplementation also shuts down the production of sperm, Werner says.
Retired trucker Dorsey used to get testosterone shots monthly, but in the last year his doctor has prescribed a pill form, after Dorsey complained that the injections would make him feel uneven—great at first but three weeks after the shot, "I'd feel like crap." Although some doctors warn against oral medication, Dorsey says the treatments increase his energy level, and he generally feels better. His hormone and PSA levels are checked monthly.
But some men are waiting for more accurate treatment. Mendocino County, Calif., engraver and artist Michael Stewart says that the new and popular AndroGel, a clear and odorless topical testosterone gel by Unimed Pharmaceuticals, was too strong for him. While it gave him "a lot of good energy" sexually and otherwise, Stewart felt as though he was getting an unnatural amount of "testosterone juice." He is more cautious, he says. Meanwhile, Stewart is waiting for a product where the user can better regulate testosterone dosage, he says.
Reconsidering Grapefruit in the Male Diet
That grapefruit you've been eating to keep those pounds away may not be good for you after all if you're a man suffering declining testosterone levels. The body's aromatase enzyme turns testosterone into the female hormone estrogen when certain substances are ingested, says Dr. Stephen Sinatra, a cardiologist specializing in anti-aging medicine. Grapefruit is one of those catalysts.
Sinatra, author of "Heartbreak and Heart Disease", also advises his male clients suffering from the symptoms of andropause to cut out alcohol from their diet and increase exercise. The aromatase enzyme is also turned on by alcohol and fat, so men with declining levels of testosterone are particularly vulnerable.
To help increase testosterone production, Sinatra, who heads the New England Heart and Longevity Center in Manchester, Conn., suggests men take zinc and vitamins C and E. Sinatra also suggests herbs, such as muira puama, and L-arginine to increase a man's libido.
Sinatra does a blood screen for all his male patients older than age 50 to check their testosterone levels. While testosterone replacement therapy is the standard for treating men with declining levels of testosterone—which can set off symptoms ranging from depression and fatigue to sexual dysfunction—some experts advocate a more holistic approach to andropause, including diet and exercise.
Loss of libido, for example, can be treated with the vasodilator ginkgo biloba, suggests Jed Diamond, author of "Male Menopause." For men hitting midlife, Diamond recommends, eat soy products, lower fat foods, vegetables and tomato products, the last of which can reduce the risk of prostate cancer. Furthermore, drinking plenty of water is a key component for healthy living.
"Some of it's common sense," Diamond says. "Some of it is working to change patterns."