Everyone has heard about menopause for women. This is due to a decrease in estrogen production from the ovaries. Men also have a fall in their testosterone, the male hormone produced in the testicles, also decreases a small amount after age 30 but becomes symptomatic around age 50. The problem affects millions of American men who have decreased sex drive, lethargy, loss of muscle mass, decrease in bone density, and even irritability\depression. This blog will discuss the problem of male menopause or andropause.
Men losing testosterone is a steady decline, 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.
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. Before starting anti-depressants, doctors caring for older men with symptoms of depression should get a serum testosterone level and replace the hormone with testosterone replacement therapy before initiating anti-depressants.
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.
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 and heart disease.
There have been poorly designed studies, just as there were poorly designed studies with women’s hormone studies, such as the Women’s Health Initiative, indicating that it might be dangerous for women to take hormone replacement therapy. The result is that these defective studies resulted in a lot of men are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is often abused to build super-normal muscle mass, and those levels at which men literally come back to life again.
Ideally men need to have their testosterone levels drawn in the morning when the testosterone levels are the highest. If the man has the symptoms described above and has a low testosterone level, they are candidates for hormone replacement therapy using injections of testosterone, topical gels containing testosterone, or testosterone pellets that are inserted under the skin every 4-6 months.
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.
Bottom Line: If you don’t feel the same way about yourself or your partner, 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 with a brief history, physical exam and a testosterone blood test.
Dr. Neil Baum's Urology Blog 