Buzz
While menopause in women is widely recognized, many are unaware that men can undergo a similar phase known as male menopause. Often mistaken for a midlife crisis, this condition, referred to as "andropause," is gaining attention among medical professionals and researchers.
Male menopause, or andropause, is increasingly acknowledged by doctors as a legitimate condition affecting middle-aged men. Symptoms range from fatigue and mood swings to reduced sexual desire and performance issues. Some experts advocate for hormone replacement therapy and other treatments to address these symptoms, which may also include lower bone density and weight gain.
"Think of it as puberty in reverse," explains Jed Diamond, a California-based psychotherapist and author of "Male Menopause" and the upcoming book "Surviving Male Menopause." According to Diamond, andropause brings about changes that are not just hormonal but also psychological, relational, social, sexual, and even spiritual.
Andropause is marked by a decline in testosterone, the hormone central to male identity. While testosterone levels naturally decrease with age, some men are more severely affected. Diamond estimates that approximately 25 million American men aged 40 to 55 are currently experiencing varying degrees of male menopause.
"Male andropause can be very subtle and gradual," says Dr. Stephen Sinatra, a cardiologist from Manchester, Conn., specializing in anti-aging medicine. Testosterone levels in men can start declining as early as 35, decreasing by about 1 to 1.5 percent each year. Unlike the sudden drop in estrogen women experience during menopause, the slow decline of testosterone in men can take years to manifest, leading to symptoms similar to those seen in menopausal women.
Common symptoms of andropause include mood swings, tiredness, low mood, decreased sexual desire, and difficulties with erections. "I just didn’t feel like doing anything," recalls Cecil Dorsey, a 68-year-old retired truck driver from Vernon, Conn. After a blood test revealed low testosterone levels nearly four years ago, he admitted, "I had no interest in anything at all."
A Fresh View on an Old Condition
While the first research on male andropause appeared in the "Journal of the American Medical Association" in the 1940s, it’s only in recent years that the U.S. medical field has begun to recognize this condition, according to Dr. Adrian Dobs, an endocrinologist and associate professor at Johns Hopkins School of Medicine.
Men showing signs of andropause are often treated for individual symptoms rather than the underlying condition. This approach can be problematic, as Diamond points out. For instance, a man diagnosed with depression might be given antidepressants, seemingly addressing the issue. However, if he also suffers from low libido—a common symptom of andropause—the medication could worsen that particular problem.
Testosterone Replacement
"Traditional treatments often fail to address the broader pattern of symptoms," Diamond explains, advocating for a more comprehensive approach to managing andropause. This might involve combining conventional treatments with testosterone replacement therapy, psychotherapy, herbal remedies, and lifestyle changes like diet and exercise.
Advantages and Disadvantages of Testosterone Replacement
Testosterone replacement therapy is the main treatment for men with low testosterone levels, though it remains a contentious topic. "The key question is identifying the specific issues men face and determining whether testosterone therapy can effectively address them," says Dr. Dobs.
"Every man should maintain a baseline level of testosterone," asserts Dobs, recommending a minimum threshold of 300 nanograms per deciliter of total testosterone. She notes that the average level for a 40-year-old man is around 500 nanograms.
Testosterone replacement therapy is recommended in specific cases, such as men experiencing significant bone density loss, which can result in osteoporosis and height reduction, or for treating sexual dysfunction when medications like Viagra prove ineffective. Additionally, testosterone therapy may help maintain muscle mass and body composition, particularly in cancer patients.
However, Dr. Michael A. Werner, a urologist from White Plains, N.Y., specializing in male reproductive medicine and erectile dysfunction, cautions that testosterone replacement therapy is "not without risks."
Experts advise men considering testosterone replacement therapy—whether through injections, patches, creams, gels, or oral forms—to monitor their PSA levels, as the therapy may elevate the risk of prostate cancer. (A PSA test assesses prostate cancer risk.) Other potential risks include stroke, liver toxicity, and breast enlargement. Interestingly, testosterone supplementation can also halt sperm production, according to Werner.
Dorsey, the retired truck driver, initially received monthly testosterone injections but switched to oral medication after experiencing fluctuating energy levels—feeling great initially but crashing three weeks post-injection. Despite some doctors' concerns about oral treatments, Dorsey reports improved energy and overall well-being. His hormone and PSA levels are monitored monthly.
Male Diet
Some men are holding out for more precise treatment options. Michael Stewart, an engraver and artist from Mendocino County, Calif., found the widely-used AndroGel, a clear and scentless topical testosterone gel by Unimed Pharmaceuticals, too potent for his needs. Although it boosted his energy levels, both sexually and generally, Stewart felt it delivered an excessive amount of "testosterone juice." He now prefers a more cautious approach and is awaiting a product that allows for better control over testosterone dosage.
Rethinking Grapefruit in Men's Diets
Grapefruit, often consumed for weight management, may not be ideal for men with declining testosterone levels. Dr. Stephen Sinatra, a cardiologist specializing in anti-aging medicine, explains that the aromatase enzyme converts testosterone into estrogen when certain substances, like grapefruit, are consumed.
Sinatra, author of "Heartbreak and Heart Disease," also recommends that men experiencing andropause symptoms eliminate alcohol and increase physical activity. Alcohol and excess body fat can activate the aromatase enzyme, making men with low testosterone levels particularly susceptible.
To naturally boost testosterone production, Sinatra, who leads the New England Heart and Longevity Center in Manchester, Conn., suggests incorporating zinc, vitamins C and E, and herbs like muira puama and L-arginine into the diet to enhance libido.
Sinatra conducts blood tests for all male patients over 50 to assess their testosterone levels. While testosterone replacement therapy is the conventional treatment for men with low testosterone—linked to symptoms like depression, fatigue, and sexual dysfunction—some experts recommend a more comprehensive approach, incorporating diet and exercise to address andropause.
Jed Diamond, author of "Male Menopause," suggests using ginkgo biloba, a vasodilator, to treat low libido. For men in midlife, he advises consuming soy products, low-fat foods, vegetables, and tomato-based items, which may lower prostate cancer risk. Additionally, staying hydrated by drinking plenty of water is essential for overall health.
"Part of it is common sense," Diamond notes. "Part of it involves breaking old habits and adopting new ones."
