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Wednesday, February 20, 2008

Male menopause: Myth or reality?

Less interested in sex lately? Tired? Grumpier than usual? Is this a midlife crisis brewing? Or are you feeling the normal hormone changes associated with aging? Hormone changes are a natural part of aging for men. But male menopause is not an accurate description. Unlike the more dramatic hormone plunge that occurs in women during menopause, hormone changes in men occur gradually, over a period of many years, the effects of which are often subtle and not noticed until much later in life. Some men are never affected by lower hormone levels at all — while some have physical and psychological symptoms that can include changes in sexual function, energy levels or mood.

While the term "male menopause" is sometimes used to describe decreasing testosterone levels related to aging, Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn., prefers the term "andropause." "There needs to be a distinction because we're dealing with two different situations," he says. "In women, ovulation ceases and female hormone production plummets over a relatively short time frame. In men, there's a gradual decline in the production of male hormones." Age-related decline in testosterone levels are also called testosterone deficiency, androgen decline in the aging male (ADAM) or late onset hypogonadism (LOH).

Male hormones over time

In general, older men have lower testosterone levels than do younger men. After age 40, testosterone levels in the blood begin to decline gradually — at a rate of about 1 percent a year. While there's a steep drop between the ages of 45 and 50, reduction in testosterone levels are rarely significant enough to be noticeable in men younger than 60. By the time men reach their 80s, about half have low testosterone. But testosterone levels vary greatly among men — and some men maintain normal testosterone levels into old age. Other men who have low testosterone levels don't have bothersome signs or symptoms.

What are the symptoms of andropause?

Lower than normal testosterone levels do not cause symptoms in all men — and signs and symptoms of low testosterone vary from person to person. Some of these signs and symptoms are a normal part of aging. The only sure way to know whether you have low testosterone levels is through blood tests.

Signs and symptoms of low testosterone can include:

  • Reduced sexual desire
  • Infertility
  • A decrease in spontaneous erections (such as during sleep)
  • Swollen or tender breasts (gynecomastia)
  • Loss of body and pubic hair
  • Small or shrinking testes
  • Height loss and thinning bones
  • Reduced muscle bulk and strength
  • Hot flushes and sweats

Other signs and symptoms can include:

  • Decreased energy, motivation and self-confidence
  • Feeling sad or depressed
  • Poor concentration and memory
  • Sleep apnea or other sleep problems
  • A low red blood cell count (mild anemia)
  • Increased body fat
  • Diminished physical or work performance

Testosterone replacement therapy

Treatment of low testosterone due to aging with testosterone replacement therapy (TRT) is controversial. The benefits of TRT are not clear, and it may increase the risk of prostate cancer. While certain men who have symptoms related to abnormally low testosterone may benefit from testosterone replacement therapy, it isn't appropriate treatment for most aging men. While it has been shown to help some men with low testosterone, TRT has risks, especially for men with certain health conditions such as prostate cancer and heart disease — and it may not improve your symptoms. More studies need to be done to determine the effectiveness and safety of TRT in aging men, and who can benefit most from this type of treatment. As it turned out with hormone replacement for women, TRT may have possible long-term risks that are not yet known.

Herbal supplements: Do they work?

Although many herbal supplements are widely marketed with the claim that they can relieve symptoms, none has been proved safe and effective for aging-related low testosterone. One of the most common supplements marketed to treat this condition, DHEA, may increase the risk of prostate cancer. More studies are needed to evaluate possible health benefits — and dangers — of taking DHEA or other supplements. Talk with your doctor before taking any herbal supplements, as some can cause side effects or cause problems with medications.

Is it low testosterone — or is it something else?

Symptoms caused by testosterone deficiency are similar to symptoms caused by other things. Signs and symptoms can include:

  • A number of other health problems such as liver disease, kidney failure, or an overactive or underactive thyroid
  • Side effects of medications
  • Lifestyle choices such as excessive alcohol use or use of illegal drugs
  • Psychological conditions, such as depression or emotional distress related to life changes that come with middle age (the so-called midlife crisis)

Steps that may help

While there's no way to avoid lower testosterone levels caused by aging, there are a few things you can do to help prevent or improve symptoms caused by the condition:

  • Eat right and stay active. Regular exercise and a healthy diet can help you maintain your strength, energy and lean muscle mass. It can also improve your mood and help you stay sharp as you get older.
  • Talk to your doctor about sexual problems. Erectile dysfunction and other sexual issues are common as men get older. Your doctor can help you find the best way to cope. Medical treatment, lifestyle changes or changes to the dose or types of medications you take may help.
  • Seek help if you feel down. Many older men suffer from depression. It often goes undiagnosed — but treatment can make a big difference in how you feel. Depression in men doesn't always mean having the blues. You may have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities.

If you are an older man and you have bothersome symptoms you think might be caused by low testosterone, see your doctor to get a firm diagnosis and find out your treatment options. While low testosterone does cause signs and symptoms in some men, your symptoms may be caused by normal aging or something else. Identifying and treating other health issues that can cause or worsen symptoms, making lifestyle changes, or changing the type or dose of medications you take may be enough.


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