Yes, males do go through menopausal changes. As the joke goes, male menopause is a lot more fun than female menopause. With female menopause you gain weight and get hot flashes. With male menopause you get to buy a sports car, date young girls and drive motorcycles.
The correct name for male menopause is “andropause”. “Andro” stands for androgen – a male sex hormone, such as testosterone, that controls the development and maintenance of masculine characteristics. The onset of andropause is unpredictable. Its clinical manifestations are subtle and variable.
The symptoms of andropause include fatigue, depression, hot flushes, sweats, decreased libido, erectile dysfunction, changes in cognition (like poor concentration and memory) and mood. Since these symptoms are more subjective than objective, some experts have trouble accepting andropause as a clinical condition.
Physical examination of an aging male patient with andropause may be quite normal. There may be presence of gynaecomastia (enlargement of male breast) and/or soft small testicles. Low testosterone level does not produce any specific organ changes.
Diagnosis of andropause is made by symptoms, physical signs and early morning non-fasting specimen of blood for testosterone level. Testosterone level is highest in early morning and can decrease by 35 percent in the mid-afternoon and evening.
Early morning testosterone level less that 7 nmol/l indicates that a man has poor testicular function. Testosterone level found to be critical for sexual function in men is around 10.4 nmol/l. There can be some variation between individuals.
Normally men experience a continuous slow (an average of one to two percent a year) decline in serum testosterone level after about age 30 years. This is due to decrease in testosterone production. There are many other reasons why testicular function may fail – injury, infection, tumours, surgery and effect of other hormonal problems.
The goals of treatment for poor testicular function are to improve erectile function, restore libido, and improve psychological well-being and mood. It is important to remember that in men over 50, cause for erectile dysfunction may be other than low testosterone level. So testosterone replacement therapy will improve libido and psychological well-being in this age group but may occasionally improve erectile dysfunction. Testosterone replacement therapy improves bone mass, coronary artery disease, reduces total cholesterol and LDL (bad cholesterol) levels.
Testosterone should not be given to individuals with prostate or breast cancer. Sleep apnea has been shown to contribute to low serum testosterone levels and testosterone therapy has been reported to make sleep apnea worse. Testosterone therapy may make blood thick (polycythemia), promote benign and malignant changes in the prostate, and can cause tenderness and enlargement of breasts.
Testosterone is available for clinical use in many forms: injectable, oral pill, skin patch, gel and implantable formulations. Each one has advantages and disadvantages. Your physician will advice you the best formulation for you. The physician should monitor the treatment to check for any side-effects and for any long term complications like prostate cancer.
So there is hope for aging men. Besides sports cars and motor bikes, there is Viagra and testosterone. You will be laughing and driving your motor bike all the way to a nursing home when you are 90 or 100. But talk to your doctor first before you put your life’s savings in a sports car.
Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!