Categories: Urology

Male Menopause – Myth or Reality

“Male menopause” is misleading, as it suggests symptoms have been caused due to a sudden drop in testosterone – similar to in female menopause and a loss of oestrogen. This is incorrect as although male testosterone falls with age, the decline is more steady – less than two percent a year from around the age of 40 – and is unlikely to cause problems later as the decline is gradual and it gives enough time for the body to adjust to these changes. It is thought that the andropause or male menopause is caused by lifestyle or psychological factors, although it may or may not be associated with a drop in testosterone levels, distinguishing it from late-onset hypogonadism. For example, symptoms such as loss of libido and mood swings can be the result of stress or anxiety, or even poor diet and lack of exercise rather than a lack of testosterone level.

A growing number of men are heading to the doctors claiming they are going through the “manopause” — or male menopause — and being given prescriptions for testosterone. The sex hormone prescriptions, such as jabs and gels, have increased by 20% since 2012. This may or may not result in the resolution of symptoms as it is perfectly possible that there is no lack of testosterone in these men.

Men can, and do, get testosterone deficiency. Obesity and various conditions such as sarcoid and pituitary gland disease can cause it. So can surgery or severe injury to both testicles. But those are very different scenarios to diagnosing ‘male menopause’. As anyone over 50 knows, life brings its challenges — relationship worries, loss of youth, trouble at work, and concerns about children or aging relatives. It might be nice to imagine this could be fixed with just a hormone prescription.

Therefore, one has to understand that there are two distinct entities – “the male menopause” and late-onset hypogonadism, certainly there are overlaps and it is difficult to separate the two at times.

Symptoms of male menopause

Depression, sexual dysfunction. mood swings, irritability, loss of muscle mass, developing a large belly, breast swelling, general lack of enthusiasm, difficulty with sleep, and poor concentration are some of the important symptoms that men can develop. These symptoms upset the normal daily activities and it is, therefore, crucial to identify the underlying cause and work out what needs to be done to resolve it.

Late-onset hypogonadism

This is a condition that can present in men in their 50’s commonly, particularly in men who are obese or have diabetes. When one has excluded lifestyle and psychological problems as the cause for symptoms of “male menopause”, it is possible that the testis is not producing hormones in adequate quantity. This is an uncommon condition and is not part of the normal aging process. The diagnosis of late-onset hypogonadism can be made based on the symptoms and the results of testosterone levels in the body.

What does a testosterone blood test do?

A simple blood test can be done to check if a man has low testosterone and if treatment is needed. It is important to measure the testosterone levels at certain times of the day, total testosterone fluctuates a lot during the day. Testosterone levels are highest in the morning, although this is less pronounced in older men, therefore an accepted practice is to check the testosterone levels between 7 am and 11 am.

Can you be treated for ‘male menopause’

It is extremely important to determine if symptoms are caused by any lifestyle or mental factors, such as stress or anxiety. If stress is the cause, they can recommend medication or behavioural therapy to help.

Exercise and relaxation can also help alleviate symptoms in most cases.

If you are considering hormone replacement therapy, make sure to discuss the potential risks and side effects with your doctor. Replacing testosterone, for example, may worsen prostate cancer and increase the risk of heart disease. It is advisable for men above the age of 45 years to have their PSA (Prostate-Specific Antigen) levels estimated before commencing testosterone replacement therapy. Testosterone can be replaced in the form of either injections, tablets, patches, implants, or gels, which can be used to correct levels of the hormone.

Lifestyle changes

Your doctor may very well recommend certain lifestyle or other changes to help with some of the symptoms of male menopause.

There are so many things men can do at home as well. A healthy lifestyle is not just about eating right and getting exercise. It’s just as important to have a good laugh, enjoy some alone time, and connect with friends. It is a proven fact that the testosterone levels are well dependent on the mental well-being of an individual, therefore one has to address issues such as lack of sleep, drinking too much alcohol, smoking, low self-esteem to overcome the symptoms of male menopause. It will be naive to think that only a lack of testosterone is the reason behind the symptoms of male menopause.

It is of utmost importance that if and when one does have symptoms one seeks advice from a clinician and a holistic approach is taken as hormone replacement may not be the only solution to this rather intriguing problem.

Dr. Saurabh Bhargava | Senior Consultant – Urology | MSMC

Narayana Health

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