Andropausing
by Lisa Barroilhet
All good things must come to an end, the adage states. As an optimist, I don't completely buy into this philosophy; as a biologist, I must acknowledge the truth behind the cliche. For example, what happens as we age? Hormone reserves become depleted, bones lose their sponginess and suddenly--my goodness--there's a bald spot where thousands of functional hair follicles used to happily reside. For better or for worse, things change as the years pass, and for both men and women there are significant milestones along the way. Menopause jumps immediately to my mind--the loss of fertility is a poignant marker of middle age in women. Until recently, the hormonal changes that occur in men as they age have not been given much lip service. Now male menopause (or andropause--referring to androgens, the larger class of hormones of which testosterone is a member) is a medically accepted term to describe the decrease in testosterone levels that occurs in men, usually between the ages of 45 and 60.
Male menopause is a distinct physiological phenomenon marked by reduced production of testosterone, the famed hormone that stimulates sexual development in the male infant, spurs bone and muscle growth throughout the adolescent years and is responsible for the much-discussed male libido. By the time a guy reaches 80, however, his testosterone level is likely lower than it was before he entered puberty, much as an older woman's estrogen level (without hormone replacement therapy) is virtually undetectable.
The symptoms of andropause are remarkably similar to the ones that women experience, however they are not as widespread. While female menopause is generally an across-the-board inconvenience, it seems that male menopause does not affect all men, at least not with the same intensity. Approximately 40 % of men between 40 and 60 will experience some degree of lethargy, depression, mood swings, insomnia, decreased libido, weakness, loss of both lean body mass and bone mass (making them susceptible to hip fractures) and difficulty in attaining and sustaining erections (impotence). The fact that andropause is not an equal opportunity annoyance is both a blessing and a curse. While far fewer men than women complain of the physical and emotional symptoms associated with menopause, much less is known as to how to best treat andropause, nor is it a topic that is freely discussed between men and their medical practitioners.
For men who experience andropause, its unanticipated physical and psychological changes can be nothing less than alarming. Decreased sex drive, difficulty maintaining an erection, and loss of strength and muscle tone can take a huge toll on any guys' s self-confidence. Thus begins a potentially vicious cycle--a man's self-esteem suffers and it becomes more difficult for him to become sexually aroused, then his inability to get an erection further reduces his self-esteem. Even though impotence is a common experience (a recent aging study showed that more than half of normal, healthy males aged 40 to 70 experience some degree of impotence - defined as a persistent problem attaining and maintaining an erection rigid enough for sexual intercourse) there is still a huge stigma attached to "erectile dysfunction."
The most effective treatment for andropause in use today is Hormone Replacement Therapy (HRT). Similar to how many women take estrogen after menopause sets in, many men are now opting to boost testosterone levels artificially. Testosterone therapy can be administered in a variety of ways, ranging from injections and creams to patches and pills. Oral preparations of testosterone are the most widely prescribed. There are no serious side effects associated with oral testosterone, but its effectiveness seems to be somewhat unpredictable. Because testosterone is a hormone that is quickly metabolized by the body, even though it's fast acting, it doesn't last long. It can be difficult to find a testosterone regimen that works for you, so it is generally recommended that anyone considering Hormone Replacement Therapy consult their physician before taking the plunge.
Probably the greatest service that can be done to assist men suffering from male menopause is to acknowledge that it is a medical condition with numerous psychological and physiological manifestations. Middle age is difficult for everybody. Women have always had a credible set of reasons to be irritable, tired, and disinterested in sex. It is time that the grumbles of aging men be heard and recognized. So go ahead! Be grouchy! Lethargic! Have a hot flash! Andropause has equalized what we thought was inherently unequal. Now men and women alike can gripe about their hormonally-induced symptoms and reassure each other that, like most unpleasant things, menopause or andropause is only a phase.
References:
"Male Menopause, Does It Really Exist?" Andrology. Online:
Accessed February 12, 2001.
"Impotence and the Male Menopause" Men's Issues. Online: Accessed February 12, 2001.
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