Menopausal Men

Q. Do men really go into menopause too? What are the signs and symptoms of male menopause? What is the treatment for this condition? — Mencio B., San Fernando City

A. As people grow older, there are significant changes in the amount and pattern of production of their sex hormones. The sex hormones—estrogen and progesterone, in women and testosterone, in men—are produced by the ovaries in the female and the testes in the male. They regulate the reproductive process and exert profound effects on many bodily functions. They are also responsible for the striking physical differences between men and women.

In women, production of the female hormones stops abruptly at age 48-52. This cessation of female hormone production is called menopause. Very often, the female body is unable to adjust promptly to this sudden deprivation of estrogen and progesterone. Consequently, many, if not most women, manifest a host of distressing signs and symptoms that are collectively referred to as menopausal syndrome, which can last for months to years.

In men, on the other hand, the testes produce testosterone (as well as sperm cells) until old age, although the amount of production starts to decline by 1-2% per year starting at age 30, and the total decline could be as much as 80% at old age. This drop of testosterone blood levels that occurs in middle-aged and elderly males, which is often called male menopause, is termed andropause. Another term for the condition, which is more descriptive, is androgen deficiency of the aging male (ADAM).

Occasionally, the decrease in testosterone production by the testes comes rapidly. In these instances, the male usually exhibits the andropausal syndrome, which is characterized by signs and symptoms that are very menopause-like. These signs and symptoms, which can seriously interfere with the man’s quality of life, include loss of sex drive, erectile dysfunction (.e., inability to achieve an erection), fatigue, loss of a sense of wellbeing, loss of physical agility, joint pains and stiffness, hot flashes, night sweating, palpitations, sleep disturbances, depression, irritability, changes in mood, decrease in mental capacity (memory and cognition), decrease in muscle mass, increase in body fat, decrease in body hair, changes in skin quality and decrease in bone mass that results in osteoporosis (brittle-bones).

In most males however, the drop in testosterone level, although progressive, comes very gradually. Consequently, relatively few men manifest andropausal symptoms although quite a number manifests depression. For this reason, some experts do not even accept the existence of andropause as a distinct medical condition. They instead attribute the depression that many middle-aged and elderly men experience to the normal aging process.

Testosterone replacement therapy can alleviate many of the signs and symptoms of andropause, but this treatment should be reserved for men with abnormally low levels of testosterone because it is not exactly innocuous.

Testosterone replacement therapy can have distressful side effects such as frequent or persistent erections, nausea, vomiting, jaundice, fluid retention, ankle swelling, musculinization of sexual partner, or disturbance in sleep pattern including sleep apnea.  It can also adversely affect many organs such as the liver, the organs of the cardiovascular system, the breast (breast enlargement) and most notably, the prostate. Testosterone replacement therapy can worsen prostate disease. It can enhance the development of prostate cancer and worsen benign prostatic hypertrophy (BPH).

(Email inquiries on health matters to: medical_notes@yahoo.com)

By EDUARDO GONZALES, MD

MB.COM.PH

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