Is Male Menopause Real? If so, what can be done about it?

To answer the question whether there is such a thing as male menopause, let's take a step back.

We all know the difference between men and women and it starts off at the gene level. Women have two X chromosomes, men one X and one Y. The Y chromosome is one of the smallest human chromosomes and on it is the tiny bit of DNA that’s required for the production of testosterone.

From Harvard Health Publications:

Testosterone has many direct effects on the male anatomy and metabolism. It is responsible for the deep voice, increased muscle mass, and strong bones that characterize the gender. It stimulates the production of red blood cells by the bone marrow. It also has crucial, if incompletely understood, effects on male behavior; it contributes to aggressiveness and is essential for the libido or sex drive, as well as for normal erection and sexual performance. Testosterone stimulates the growth of the genitals at puberty, and it is responsible for sperm production throughout adulthood. Finally, and for most men unhappily, testosterone also acts on the liver, raising the production of LDL (“bad”) cholesterol.

Similar to the way that women experience drops in sex hormones (for them its estrogen) as they age, men also see a reduction in their sex hormone, testosterone. In women, the bulk of this drop happens starting around age 50 and then plunges suddenly over a 5 year period. It's called menopause and because the symptoms are so clear (including the cessation of menstruation cycles), there is no question when it happens.

The pace of hormonal changes in men is quite different. Instead of happening in a condensed period in midlife, it starts in the 30's and drops gradually after that (around 1 percent per year). The slowness of the decline means that the effects can be equally slow to appear and may not even be apparent until well into middle age or older. Even measuring testosterone levels is difficult for various reasons. Finally, when they symptoms (less energy, lower libido, irritable, etc.)are noticeable are they due to testosterone levels or something else entirely? It's not easy to know because there are other conditions that can cause the symptoms associated with testosterone deficiency. Furthermore predicting which men will benefit from hormone treatment is tricky. The Newsweek cover story on menopause (male and female) sourced for this posting is certain to stir even more interest in the topic.

Six years ago, Harvard Medical School asked the following question "should healthy men consider testosterone therapy to reverse some of the changes that occur with aging?" Their response:

...there’s no good answer yet. That’s because scientists have not conducted long-term studies of testosterone in healthy men. Small, short-term studies, though, illustrate the potential for testosterone therapy as well as its possible perils.

Testosterone has potential advantages: it can increase muscle mass and strength; it can improve bone density, and it can boost red blood cell counts. It’s far from clear, though, if it will improve libido, erectile function, or sexual performance in older men; several small studies have been disappointing thus far. And long-term therapy has potential risks, including abnormal cholesterol levels and possibly heart disease, liver damage, excessive red blood cell counts (polycythemia), sleep apnea, and prostate stimulation, which could increase the risk of BPH and prostate cancer.

Despite the obvious appeal of testosterone replacement for older men, most doctors advise against it; on balance, the risks seem to outweigh the benefits. But that doesn’t mean men have to accept the down side of aging. Far from it; in fact, there are simple ways to get many of the benefits of testosterone without its risks. Along with a healthy amount of dietary protein, resistance exercises and other forms of strength training will help preserve muscle mass and strength, bone density, and musculoskeletal function. Taking adequate calcium (1,200 mg a day) and vitamin D (400–600 units a day) will help prevent osteoporosis. Above all, perhaps, a program of regular exercise and a low-fat, high-fiber, vegetable-and fruit-rich diet will help prevent atherosclerosis, hypertension, and diabetes—the three major causes of illness, disability, and impotence in older men.

With all of the conflicting and confusing information what should you do? First off, "symptoms due to testosterone deficiency in men older than 50 definitely occur and can be diagnosed and treated. As many as 10 million U.S. men may be affected. As the baby-boomer generation ages over the next 25 years, this number is expected to rise significantly." In other words, it's worth you looking into if you even suspect a problem.

If you are older than 50 and have symptoms, see your doctor. Second, unless instructed otherwise by your doctor, you should be employing the healthy living tips listed above whether or not you've been displaying symptoms.

See also Andropause Factoids

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