What do we know about Male Menopause?

Menopause in men or just mid-life crises

Depression, irritability, Weakness, loss of libido (sexual dysfunction), mood swing, Inability to concentrate, loss of memory, decrease energy, decrease muscle mass, increase fat are some of the menopause symptoms in Male

What causes the male menopause

After the age of 30 years a man’s testosterone hormone levels start to drop, about 1% each year. Most men in their seventies have at least 40% less testosterone in their system than they did when they were 30.

However, the normal decline of testosterone levels that comes with age is not believed to be the cause of male menopause. If it were, every man would experience it, and this is not the case.

Although male menopause occurs in older men whose testosterone levels have declined, it tends to affect older males with heart disease, obesity, hypertension (high blood pressure) and/or type 2 diabetes.

In other words, unlike the female menopause, several factors together contribute to the development of male menopause.

Some underlying health problems, lack of exercise, smoking, alcohol consumption, stress, anxiety, and sleep deprivation could also be key factors.

Psychologists suggest the male “midlife crisis”, when men are supposed to wonder what they have accomplished so far professionally and personally, can be a cause of depression and might possibly trigger a cascade of factors that lead to symptoms associated with male menopause.

Do men actually suffer from menopause symptoms too, are there ways to be diagnosed and treated here in the Gambia?

There is menopause in men but the most do not realize that men experience a change in their hormonal production and balance that in many ways is very similar to women’s menopause. It is called by men andropause or menopause in men. In fact, andropause is often referred to as “male menopause”.

Men go through a change very much like women in their middle years, they like women, experience complex hormonal rhythms that affect their sexuality, mood, and temperament. But some men don’t experience much of a crisis; they just continue living through the first part of their life and the second. Others go through a period of great turbulence, but then are redeemed and find a new course and approach for the second passage of their lives.

And, of course, every person is different. And not all men going through this stage of life will experience it exactly the same way. The passage into middle age is a complicated. It has many personal, social, economic and family implications. It may therefore be difficult to differentiate these changes from the symptoms of other conditions that can create some of the same symptoms.

Men menopause occurs when a man’s production of hormones declines to below normal levels. These hormones include testosterone (man’s hormone), thyroid, and human growth hormone (HGH). In addition, production of oestrogen’s (female hormone) actually increases in men undergoing menopause.

A man’s testosterone level typically begins to fall by the time he reaches his 50s, but for many men it may start to occur in his early 30s. The diagnosis of menopause in men should include complete blood count and chemistry profile, which can be tested in various labs in The Gambia.

The balance between the testosterone (man’s hormone) and oestrogen’s (female hormone) is very important. While some oestrogens protects against osteoporosis (bone’s degeneration) by increasing bone density and may decrease the risk for prostate cancer, men’s testosterone level should be greater than their oestrogen’s level. In many men over fifty, the oestrogen’s level is greater than the testosterone level, which is unacceptable.

The choices for supplementation of testosterone in males are quite numerous at this time, but only a few are commercially available. Patients and their physician have options to choose from that best fit their needs which include: topical gels, creams, oral capsules, and inject able forms.

Patients taking testosterone supplements should have their testosterone and oestrogens’ levels measured after four to six weeks to determine if they are receiving the proper dose of medications.

The goal of therapy in treating male menopause is hormone replacement to achieve younger, healthier levels in order to reverse the signs of menopause and the effects of ageing. Treating male menopause may also have positive effects on blood pressure, diabetes, heart disease and arthritis.

Male Menopause begins with hormonal, physiological chemical changes that occur in all men generally between the ages of forty and fifty-five, though it can occur as early as thirty-five or at late as sixty-five. These changes affect all aspects of man’s life. Male menopause is thus a psychological, interpersonal, social and spiritual dimension. Men have reported having as many premenstrual type symptoms as women do as mentioned (reduced or increased energy, irritability, and other negative moods, black pain, sleeplessness, headaches, confusion, etc.).

Hormonal changes greatly affect men going through male menopause, louvred levels of hormones at mild- life are central to the changes associated with male menopause.

Recent research indicates that lowered levels of man’s hormones may decrease sex drive, increase depression and weight gain, and contribute to a general decrease in wellbeing and health:

Men, like women, experience complex hormonal rhythms that affect their sexuality, mood, and temperament. Studies show

Four different testosterone cycles in men:

•Rhythmic fluctuations three to four time an hour.

•Daily changes with testosterone higher in the morning and lower in the afternoon.

• Monthly fluctuations that is rhythmic, but different for each man.

•Decreasing levels of testosterone associated with male menopause that occurs as men get older.

A man often begins to experience changes in his body somewhere between the ages of 40 and 55. These bodily changes may be accompanied by changes in attitudes and moods. The aging process alone can not be responsible for this problem as well over 40% of males remain sexually active at 70 years of age and beyond.

Acute andropause in men is relatively uncommon, compared to acute menopause in women, because testicular function declines gradually in most men. There are a number of other causes, however, for acute testicular failure in adult men and these include: viral infections such as mumps, surgical removal of or surgical injury to the testes and male reproductive tract, diseases when the immune system attacks and destroys the testes such as subtle genetic abnormalities which permit normal adult development but lead to premature testicular failure, generalized diseases such as diabetes, chemotherapy, and brain tumours (rare).

The second form of this syndrome (disease), while more common, is more insidious since it occurs gradually. It is often confused with male mid-life psychological adjustment disorders because it exactly mimics depression in midlife men. Some known contributors to this condition are excessive alcohol consumption, smoking, hypertension, prescription and non-prescription medications, poor diet, and lack of exercise, poor circulation, and psychological problems.

Male hormones decline gradually. Testosterone (from the testes), human growth hormone (from the brain) levels all begin to drop. For many men this does not occur until their 60s or 70s but there are others where it occurs much earlier.

In addition, there are proteins in the blood which bind testosterone into a biologically inactive form - sex hormone binding proteins or globulin. Their levels can rise in response to many conditions including medical disorders and exposure to other hormones such as an example, there is some data suggesting that men on low fat or vegetarian diets have lower testosterone (man’s hormone) levels. The overall effect of rising sex hormone binding proteins is that there is less bio-available testosterone.

Signs and Symptoms

Typical symptoms include:

• Fatigue, loss of a sense of wellbeing -- 82%

• Joint aches and stiffness of hands -- 60%

• Hot flashes, sleep disturbances -- 50%

• Depression -- 70%

• Irritability and anger -- 60%

•Reduced libido -- 80%

•Reduced potency -- 80%

• Premature aging

• Weight gain

•Hot flashes, which occur only in approximately 1 in 10 men

•Osteoporosis (weakening or loss of bone mass)

•Hair loss in armpits and genital area

• Shrinkage in size of sexual organs.

Diagnose Male Treatment

If a man is experiencing a few or all of these symptoms, it is important to get a full exam from a doctor. This exam will rule out any other conditions or medical problems such as diabetes, which can also be the cause of low testosterone. A doctor will give man Treatment Options

Men often do not seek treatment for andropause. A lot of men feel uncomfortable speaking about their symptoms and, in the past, doctors haven’t taken men’s menopause seriously. Signs of menopause in men can also be difficult to diagnose. Thanks to new studies, though, doctors have become more aware of this problem and are beginning to realize the importance of treatment.

The primary treatment for andropause is Testosterone Replacement Therapy (TRT). Like oestrogen’s replacement in women, testosterone replacement aims to bring hormonal levels back up to a healthy level. Once testosterone levels are increased, most men begin to experience fewer symptoms. Unfortunately, testosterone replacement doesn’t always work well to combat erectile dysfunction. Because this is such a severe symptom for most men, other treatments for erectile dysfunction should be investigated.

It is important for men to understand what is happening to their bodies as they age. Andropause does not affect all men and its symptoms have varying degrees of severity. However, if you know someone who is affected by andropause, encourage him to talk about his symptoms with a doctor.

Blood tests including a blood testosterone level test.

Treatment Options

If it is found that a man has low testosterone, your doctor may recommend testosterone replacement therapy, which could help relieve the male menopause symptoms. This therapy can be done through patches, injections, gels, creams and oral form. Before any treatment begins, discuss the pros and cons of having testosterone replacement therapy with a doctor.

Where in the Gambia

There are various Government Hospitals, EFSTH, MRC, NGO and private Clinics in the country where you can visit for further information, be diagnosed and undergo available treatment. Email azadehhassanmd10@gmail.com\ ,Text to 002207774469/3774469.

Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director Medicare Health Services.