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.
