Male Menopause: Myth or Reality?
So the male menopause joke is than men have a lot more fun in menopause because instead of what women go through: an abrupt halt to the production of sex hormones often resulting in, among other symptoms, hot flashes and weight gain, men get to flirt with young women, buy sports cars, and ride motorcycles.
While that may sound like more fun, the collateral damage of a man’s slowly declining levels of testosterone – beginning at age 25 we start losing 1 to 2% of our testosterone production a year – often has far reaching effects.
The age-old and heralded mid-life crisis for men usually includes, in the movies at least, a fascination with younger women, the desire for adventure, and the need for additional horsepower in the form of a hot sports car or a bigger gun. Each of the predictable reactions are there to head off the real symptoms of declining levels of androgen – the male hormone:
A return discussion on hormones with Paul Cox, an Atlanta physician specializing in anti-aging medicine and bio identical hormone replacement, (last week Dr. Cox helped us understand new findings on an older study of women’s hormones) has him revealing what he thinks is the biggest problem facing men in their 40s, 50s, and 60s, when the “slow leak of testosterone levels takes its toll over twenty, thirty, or forty years,” and most men slip into “just not giving a damn about a lot of things.”
“I see it all the time; often times when a female patient finally begs, threatens, or somehow cajoles her husband into coming in because he just seems to have given up on a lot of things. She complains that he’s just sitting on the couch, has lost interest and drive with regard to work, and just doesn’t care. It’s that apathy that is so damaging,” said Cox.
“The thing is,” he continues, “this is not like female menopause, where there is a signal that it has stopped because there is no longer a menstrual period. Men losing testosterone is a steady drip, like a leak in a swimming pool you never refill. Over time, you empty out all your stores, creating a constellation of problems.”
The constellation of problems compound each other, too. The apathy comes in part from the decline in hormones, which results in loss of lean muscle mass, depression, and forgetfulness. But it becomes a downward cycle, as the less lean muscle mass a person has, the faster he or she gains weight, which leads to more depression.
Then there is the problem with men self-medicating their depression, problems with sleep, and the loss of sexual function. Many men self-medicate with alcohol, which is actually a depressant, and exacerbates the core problems with side effects including weight gain, elevated blood sugar, and, ironically, sexual dysfunction and problems achieving a deep, restful sleep. So while the stiff shot of whiskey in old Westerns may give a man a bit of liquid courage, the long-term effect of alcohol is likely to increase his depression and exacerbate the very problems a man is trying to alleviate.
The seriousness of the problem of male depression tied to aging cannot be denied, as middle-aged and older men account for more than 20 percent of suicides, as compared to about 5 percent for women. Older white males represent 70 percent of suicides.
“Most of my physician referrals come from psychiatrists and neurologists, as men are seeing them because of depression and memory issues. Psychiatrists and neurologists know what a reduction in testosterone does to emotional well-being and brain function. These specialists want their patients to be tested for low testosterone before trying anti-depressants or other prescription therapies,” said Dr. Cox.
The reason more general physicians don’t think of, or want, to go the hormone testing route? Testosterone therapy got a bad rap a few years ago when there was a lot of misinformation with regard to testosterone being dangerous and possibly being linked to an increase in prostate cancer.
“There have been poorly designed studies, just as there were with women’s hormone studies, indicating that it might be dangerous. The result is that a lot of people are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is gauged for where people are often actually is fat and sick, and optimized, which is the levels at which issues are alleviated and people literally come back to life again,” Cox said.
“To optimize testosterone,” Cox said, “I need patients to come in for an for hour so we can find out issues and complaints. We have to draw labs first thing in the morning or values are meaningless. When the labs come back we sit down with the patient and talk with them – based on labs and complaints – to see if they are a candidate for optimizing testosterone. If we can optimize testosterone, we will see a patient become happier and healthier.”
Cox says he has literally seen men “come back to life,” saying they really didn’t know how bad they felt until they felt better.
“Suddenly they say, ‘I am interested in my life again.’ Many of these men come in saying they feel like half a man; well they are, because they are trying to live on half the amount of testosterone they had when they were younger. When they feel better, they make changes such as losing weight, or changing careers, because with the low level of testosterone, they didn’t care enough to do it before,” Cox adds.
The same vibrancy that men who are treated feel in life often translates back into their marriages.
“If you don’t feel the same way about yourself or each other, and you are in your 40s, 50s, or 60s, it may well be that one or both of you have hormonal issues. It makes sense to try and fix that before you go through the trauma of an affair or a divorce,” Cox added.
Maybe this year instead of that run to the diamond store for her, the better gift for a man is to give himself, and his wife, the gift of taking good care of himself with a thorough physical, including a check of his testosterone levels, and the willingness to consider male hormone replacement therapy.
Paul E. Cox, MD, MS