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Male menopause – symptoms and treatment

Dr Sanjay Agrawal
Wednesday, May 21, 2014, 08:00 Hrs  [IST]

When men reach their late forties to early fifties, they experience decreased sexual function, declining mental and physical abilities, and greater psychological problems. These are all indications of male menopause; medically termed as ‘Andropause’. Many men may present themselves late for medical treatment, as the onset of male menopause may be quite insidious. Also, the symptoms are rather vague; so many men are misled into thinking and accepting the symptoms as part of ageing. Changi General Hospital (CGH) in Singapore has set up its Andropause and Men's Health Clinic where men can screen for the condition and seek treatment.

Do doctors use the term "male menopause"? No. A health care professional may use the term andropause, testosterone deficiency, or late-onset hypogonadism. Hypogonadism refers to a deficiency in male hormones, where levels are too low even for an aging man. The meaning of late-onset hypogonadism is more similar to what lay people and the media refer to when discussing "male menopause".

Some lay people use the informal term "man-pause".

Understanding male hormones over time.Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood - about 1 per cent a year after age 30 on average. By about age 70, the decrease in a man's testosterone level can be as much as 50 per cent. ‘Androgen’ is an alternate name for the hormone ‘Testosterone’.

What is male menopause?
As a man ages, his testes will produce less male hormone, or testosterone. When the testosterone drops below certain levels, he will suffer the symptoms of low testosterone, or Male Menopause.

The male menopause is much less sudden. The signs and symptoms appear more gradually and delicately, and the decrease in male hormone (testosterone) levels steep. Andropause itself is not exactly menopause in men. For women, the estrogen decline is severe and sudden during menopause whereas the testosterone decline is much more gradual for men. Many men do not notice the deterioration of their condition as the process is more drawn out. Moreover, the testes still produce sperm, even though at a much lower level.

What are the symptoms?
Low level of this hormone may lead to impotence and a decreased sexual drive. Fluctuation of mood is very common thing. The man may also lack the motivation to work and face the world, and cannot remember things as well as before. Increase in body fat and hence body weight is also increased. His bone mass decreases in a condition termed osteoporosis, which puts him at a higher risk for bone fracture. And all leads to depression. Overall his body metabolic activities get reduced so there is reduction in energy levels and male feel early exhausted.

How is a diagnosis of Testosterone Deficiency Syndrome made? Initially it’s an awareness that it exists that’s the biggest uncertain block. Once somebody thinks, ‘this situation exists, there is a condition Testosterone Deficiency Syndrome’, you’re halfway there. A good history and clinical examination with a completed questionnaire which points in the right direction, then you’re on to measurements of your blood certain blood characteristics and then you’re probably on to a trial of therapy lasting 3 months.

Who diagnoses testosterone deficiency syndrome?
This would be your general physician (GP) in the first instance having a sense that this might be the area of concern and then it probably requires referral to the hospital although some GPs are getting very aware of it now and are getting much better at diagnosis. If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options.

How can be treated?
You can't boost your natural testosterone production, but these steps might help:

  • Be honest with your doctor. Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms from medication side effects to other issues without any hesitation.
  • Make healthy lifestyle choices. Menopause in male is a natural process and a man can help himself by developing a healthy lifestyle in order to delay its onset. Eat a healthy diet and include physical activity in your daily routine. He should have a well-balanced diet, with limits on sugar, fat and salt. He should not smoke and drink excessively. Regular exercise will also help. Just a nice twenty minute walk three times a week can help maintain and control fat build up. Another natural treatment is to increase your Vitamin C intake. Increasing your Vitamin C intake to 1,000-3,000 mg a day for about a month or two will also prevent testosterone levels from being reduced. Taking minerals, vitamins and amino acids in a rational amount work to decrease the levels of free radicals will help to protect the pituitary gland that controls hormone production. Include fresh and green vegetables intake in your diet, including broccoli, Brussels’ sprouts, cabbage, and cauliflower. The next is to take soy products. Drink one cup of soymilk a day. If you don't like soymilk, you can take isoflavones supplement with a medical advice. Thing to be remembered in dietary treatment is that whatever you are eating should be proportionate because excessive intake is also harmful. One last thing to do is to stop eating grapefruit; it acts as enhancer to decrease level of testosterone in body. Healthy lifestyle choices will help you maintain your strength, energy and lean muscle mass. Regular physical activity can even improve your mood and promote better sleep.
  • Seek help if you feel down. Depression in men doesn't always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, too much smoking, using illicit drugs or seeking thrills from risky activities.
  • Be wary of herbal supplements. Herbal supplements haven't been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.
  • Androgen replacement therapy. Treating aging-related low androgen with androgen replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however particularly older men the benefits aren't clear. The risks are a concern as well. Excessive level of androgen might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the procedure and concentration. Other medical treatment available for male menopause. There are capsules or the injections. One can consult medical doctor for advice.

What are the misconceptions about testosterone replacement therapy?
It was initially thought that testosterone replacement lead to prostate cancer, however, this is true only in some cases of excessive intake of androgen. Then it was thought it might affect the heart but it doesn’t affect the heart adversely at all. Then people worried that you would be turned into a raging bull, if I can use that expression and again that doesn’t happen. If you are deficient and treated you actually become more tempered in your nature and less depressed and more awake. Overall you will be in full of zeal, vigour and endurance.

(Author is a medical consultant and editor in chief of IJMToday)


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