Understanding Male Menopause

Florence Barrett-Hill

Male menopause (viropause or andropause)
Andropause begins with hormonal, physiological and chemical changes that occur in all men, generally between the ages of forty and fifty-five, though it can occur as early as thirty-five or as late as sixty-five.
These changes affect all aspects of a man’s life. Male menopause is, thus, a physical condition with psychological, interpersonal, social and spiritual dimensions.

The purpose of male menopause is to signal the end of the first part of a man’s life and prepare him for the second half. Male menopause is not the beginning of the end, as many fear, but the ‘end of the beginning’. It is the passage to the most passionate, powerful, productive and purposeful time of a man’s life.

The most common physical symptoms of male menopause include:

  • Taking longer to recover from injuries and illness
  • Less endurance for physical activity
  • Feeling fat, gaining weight
  • Difficulty reading small print
  • Loss or thinning of hair
  • Sleep disturbances
  • Hot flushes
  • Joint problems
  • Changes in hair and skin
  • Urinary problems e.g.-frequent; incontinent; difficulty starting 

The most common psychological symptoms of male menopause include:

  • Irritability
  • Indecisiveness
  • Anxiety and fear
  • Depression
  • Loss of self-confidence and joy
  • Loss of purpose and direction in life
  • Feeling lonely, unattractive, and unloved
  • Forgetfulness and difficulty concentrating

The most common sexual symptoms of male menopause include:

  • Reduced interest in sex
  • Increased anxiety and fear about losing sexual potency
  • Increased fantasies about having sex with a new and younger partner
  • More relationship problems and fights over sex, love, and intimacy
  • Loss of erection during sexual activity
  • Reduced Fertility

Impotence can be a significant problem for men going through male menopause. Impotence is defined as the persistent inability to attain and maintain an erection adequate to permit satisfactory sexual performance.

A study found that although psychological factors play a role as men age, physical factors are more significant.

There was a high correlation between erection dysfunction and heart disease, hypertension, diabetes, as well as with the medications that are often taken to deal with these problems.

Since the physical, psychological and sexual aspects are interconnected, most all these symptoms can be prevented and treated by concentrating on the man holistically. 

Hormones, Male PMS and Health Problems
Hormonal changes greatly affect men going through male menopause. Lowered levels of hormones at midlife are central to the changes associated with male menopause.

Recent research indicates that lowered levels of the following hormones may decrease sex drive, increase depression and weight gain. Thus contributing to a general decrease in well-being and health: (very similar to female menopause)

Hormones: Dopamine, oxytocin, vasopressin, growth hormone, melatonin, DHEA, pregnenolone, thyroid hormone, and testosterone.

Although these hormones tend to decrease with age, each man is unique and individual levels vary widely. Some researchers now believe that giving men replacement hormones may allow them to remain vital and healthy into their sixties, seventies, eighties, nineties, and beyond. Since significant research on hormone replacement therapy for men is new, men should be cautious about taking hormones and should only do so under supervision of a physician trained in this medical specialty.

Men, like women, experience complex hormonal rhythms that affect their sexuality, mood, and temperament.

For instance, researchers have found five different testosterone cycles in men:

Men have physical and emotional reactions to hormonal fluctuations throughout the month, similar to PMS in a woman. In a recent study, when men were given the same checklists of symptoms from a typical PMS questionnaire–omitting the female specific symptoms, such as breast tenderness. Men reported having as many premenstrual type symptoms (reduced or increased energy, irritability, and other negative moods, back pain, sleeplessness, headaches, confusion, etc.) as women do–when the symptoms aren’t called PMS.

Although not all the causes of male menopause have been fully researched, some factors that are known to contribute to this condition are:

  • Hypothalamic sluggishness,
  • Hormone deficiencies,
  • Excessive alcohol consumption,
  • Obesity,
  • Smoking,
  • Hypertension
  • Prescription and non-prescription medications,
  • Poor diet, lack of exercise,
  • Poor circulation,
  • Psychological problems, Notably mid-life depression.
  • Working too hard

A general decline in potency at mid-life can be expected in a significant proportion of the male population. A relative increase in circulating levels of estrogen (which competes with testosterone for cellular receptor sites) can tilt the testosterone- estrogen balance unfavorably and can reduce the availability of testosterone to target cells.

Perhaps the principal reason male menopause has never been in the public spotlight is because men who experience the characteristic decline in virility during middle age, are reluctant, or even unwilling, to acknowledge the condition. As if the Menopause were not enough, MID LIFE CRISIS can also creep up at this time. This is often a time in life when stability has been achieved and the struggles that were once a large part of life are now at an end.

For some men, newfound stability may signify an end to vitality or youth. Many men find that after spending a lifetime working towards goals of family and peers, the result is unfulfilling, often frustrating. This is also often a time of change, major shifts in career, marriage and parenting. In addition, along with the physical signs of aging comes a realization of impending old age and retirement.

Male menopause, or more correctly, a testosterone deficiency can be a serious problem for those men afflicted with it and unfortunately the condition often goes undiagnosed and untreated. A testosterone deficiency should be high on the list of possible problems in a middle-aged man, but physicians tend to overlook the symptoms. 

How to Beat Male Menopause

  • Eat right. The traditional Asian diet, with its foundation of rice or other grains. An abundance of vegetables, fruits, beans, tofu, and legumes. A limited amount of meat and other animal foods, and virtually no dairy products, is a good foundation for healthy eating.
  • Stay physically fit. Engage in regular exercise that includes the following components: cardio-respiratory (aerobic) endurance, muscular strength, and flexibility. This always seems to indicate that one should be off to the gym. I believe however, that walking, swimming, tai chi, yoga or water aerobics are better non impact forms of exercise and all fulfill the components required for a well exercised body.
  • Take vitamins and supplements for health.
  • Take herbs to balance the system and protect the prostate.
  • Get regular health checkups. Regular health care visits and screenings are important contributors to men’s health and longevity yet according to Kenneth Goldberg, M.D., men make 130 million fewer doctors visits a year than women.
  • Check hormone levels as you get older. Generally, between forty and fifty-five a number of important hormones in a man’s body, begin to decline.
  • Reduce stress and worry in your life. Stress is a major source of trouble for men at midlife.
  • Embrace sexuality appropriate to the second half of life. In the second half of life, a man’s sexuality expands to include more emphasis on friendship, love, intimacy, and spirituality. 

Testosterone Replacement Therapy (TRT)
TRT for men using Testosterone has been shown to be effective in relieving symptoms. Restoring drive, health, potency, a sense of renewed vitality and virility when the right preparations are given to the right patients in the right doses at the right time.

To ensure its safety and effectiveness however it is essential that a full assessment or “work-up” of each patient is carried out before hormone replacement is started, and that the results of treatment are carefully monitored.

For this purpose, careful history taking, examination and blood tests are needed to establish the diagnosis and to monitor the treatment properly. Laboratory measurements of the sex hormones and the complex range of factors regulating their action, together with tests of blood fat, liver, kidney, and prostate function, all need to be checked before treatment and at each follow-up assessment.

The availability of testosterone treatment is rapidly increasing world-wide, as more doctors become convinced of the benefits and safety of TRT for men.

In many parts of the world, the two main safe oral preparations, Testosterone Undecanoate (Andriol or Restandol made by Organon) and Mesterelone (Pro-Viron made by Scherring) are available, as well as Testosterone Pellet Implants, also made by Organon. Transdermal Testosterone in the form of body or scrotal patches or creams is also available in most countries. In the USA, Testosterone is mainly available either by patches, or injectable forms such as Testosterone Enanthate, though it is hoped that Andriol may soon also be available there.

The choice of preparation will depend on availability, safety, and the socio-economic status of the patient, proven long term safety and efficacy and the preference of the patient and the prescribing specialist.

Just as there are risks for women who choose estrogen replacement therapies men should be aware of the risks associated with testosterone replacement therapy before beginning treatment. These risks include an increased risk of acceleration of undiagnosed prostrate cancer and enlargement of the prostate gland. Men should carefully weigh the risks and benefits together with their physicians to determine what is best for them.

Male andropause is easy to treat and to prevent with proper medical supervision. If you are experiencing, the signs of andropause discuss your symptoms with your doctor. 

Suggested Reading

The Andropause Mystery: Unraveling Truths About The Male Menopause
by Robert S. Tan, M.D. MBA
Don’t miss this comprehensive guide to the hormonal changes experienced by men.

Male Menopause
by Jed Diamond

An outstanding book that offers comprehensive information about changes experienced by men. Includes information about alternative prevention techniques.

Well that will be enough for now. Suffice to say that if you are thinking of expanding your clinic services into the male sector, you have a lot of reading to do to be as knowledgeable about male health issues as you are about your female clients and their health.

During the creation of this article,  I checked the Internet (Google) for information on male menopause; there was 80,900 sites to choose from, and for female menopause 90,500 sites.

Obviously, we are not on our own when it comes to THE MENOPAUSE.