TACKLING MALE MENOPAUSE
It is a known fact that hormonal changes are a normal part of our aging. Unlike the dramatic decrease in reproductive hormones in women during menopause, there are changes in sex hormones in men as well. It also looks like something seems to happen to men as they age! Interestingly, earlier during the last century the term climacteric male instead of male menopause was in use. This became more appropriate because it refers to a decrease rather than a significant or brisk decrease in hormone concentrations.
However, years later another study described that symptoms like depression, decreased libido, easily fatigued and poor concentration, reversed by testosterone replacement rather than placebo, seen in men with age-related decline in testosterone concentrations.
Due to the similarity of most symptoms between men and women, the term ‘menopause’ has gained popularity and unfortunately is stuck!
If I could say that when I compare it with female menopause, men go through less significant changes.
For instance, the production of testosterone decreases gradually, which is about one per cent per year by the age of 30.
Nevertheless some continue to produce sperm. In other words, not all men experience it. Some do not suffer from lack of testosterone or sperm production at all.
Some men with markedly low levels of testosterone have no symptoms, and some men who have normal testosterone levels for their age report symptoms.
In addition to advancing age, low testosterone levels can occur due to certain medications, hormonal disorders, radiation or chemotherapy treatment, testicular injury or chronic illness such as diabetes, kidney disease and obesity.
Remarkably, there is still no official name for male menopause, which could expressed late onset hypogonadisim or even (androgen decline in the aging male) termed as ADAM.
The menopausal symptoms appear in men during their fifties with general fatigue, tension, sleep disturbance, sweating, memory problem and poor self-confidence, but what make menopause disturbing for men is low sexual capacity, ejaculation, and a decrease in the amount of semen and pleasure.
Moreover, the goal of treating menopause is to restore hormonal activity that weakens. Thus, the body replaces hormones that are available in various forms of pills and patches, but they are not as effective.
Tablets are easy to use, but they have large drawbacks because they do not provide the right amount of male hormone for the body. While injections are most effective, their use is difficult because the patient should continue to take an injection every two or three weeks for instance.
Unfortunately, treating age-related low testosterone with testosterone replacement therapy is controversial.
For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency.
For others, the benefits aren’t clear and there are possible risks.
Dramatically, testosterone therapy contributes to sleep apnea, stimulates non-cancerous growth of the prostate and stimulates growth of existing prostate cancer.
Testosterone therapy may also increase the risk of heart attack and stroke.
A study by Harvard researchers found no clinical reason to prescribe testosterone replacement therapy to men over age 65 years who have normal or low-to-normal testosterone levels.
Though, if you are feeling that you are going through ADAM or menopause , should indeed take it seriously, because they may actually have another issues with similar symptoms, such as medication side effects, thyroid dysfunction, excessive alcohol use, or obstructive sleep apnea.
As a patient you need to weigh the pros and cons of treatment together with your physician and remember to manage stress, optimise your health and enjoy your life entirely.
Dr Yousuf Ali al Mulla, MD, Ministry of Health, is a medical innovator and educator. For any queries regarding the content of the column he can be contacted at: dryusufalmulla@gmail.com