Magazines

Back to October 2008 Issue

Male Menopause? It's Not Just for Women Anymore!

By Dr. Parnell

     Joe is a pretty typical guy in his mid-50s. He loves his wife and kids, works hard at his job and always looks forward to the weekends for a little golfing with the guys and relaxing with his family. They’ll plan to barbeque with friends on Saturday night and visit his mother, now widowed, on Sunday. I’ve been Joe’s family doctor for many years now. He’s on my schedule today for his annual exam. His weight has been creeping up especially around the mid-section. We’ve been watching his blood pressure and cholesterol closely as Joe’s dad died in his 60s of a heart attack. Joe and Joe’s wife Sue, want him to avoid that fate. He has good intentions to exercise, but lately just doesn’t have the energy to do so.
      As I enter the exam room, I note that Joe has aged in the last year. His hair has receded some at the forehead. His shoulders are a bit more rounded and he doesn’t sit as straight in the chair. We talk about his family’s summer vacation up north and the fun they had at the lake. He has a daughter in college and we agree that the tuition is too expensive.
      I asked Joe a series of questions to see how he’s been doing. He noted that he just isn’t as strong as he used to be. He needs more help with the heavy chores and seems to tire more easily. He hasn’t been sleeping as well either. Nothing in particular is bothering him, but he wakes in the night, and sometimes finds that his forehead and neck have been sweating. He’s been struggling some at work too, and finds it more difficult to have the confidence and clarity of mind that used to be there.
      When I ask a few fairly personal questions, he admits that he’s been more interested in the frequent television commercials about “ED” and that his wife has asked why he is not as interested in love-making as he used to. He’s noticed that also, but doesn’t know why.
As many people know, and Joe is about to find out, the “change of life” isn’t just for women anymore. This change is called andropause in men and can be an embarrassing and frustrating condition. In fact, as men age they may go through the same type of hormonal changes as their female counterparts, with an eerily similar list of devastating symptoms: muscle loss, decreased bone density, weight gain, cognitive decline, insomnia, depression and even hot flashes. There are some symptoms that set men apart, such as hair loss and prostate enlargement. Low libido is one of the more frustrating aspects of andropause and can put a damper on what once was a satisfying sex life.
      The problem for Joe and others like him is a low testosterone level. Testosterone is the hormone that makes men masculine, and is responsible for many of the things women really like about men. Believe it or not, only about 2 percent of a man’s testosterone is actually active. The rest of the circulating testosterone is bound tightly to proteins in the blood. This small amount of “free testosterone” is responsible for its many actions in a man’s body.
      Men who have low testosterone levels have many complaints; often they are somewhat vague and hard to define for men. Some of the more common things they notice are the fact that they look older in the mirror. I will notice a decrease in muscle tone in the face with small wrinkles at the corners of the eyes and small vertical wrinkles on the upper lips. Their belly is bigger and they have lost muscle mass and strength. They complain of persistent fatigue that increases with physical activity and lack endurance when exercising.
They will sometimes note they are more indecisive and hesitating and report trouble with memory and poorer concentration. They have lost self-confidence and may admit to being depressed. Some will have an excessive sensitivity to difficulties with more anxiety and fear. There is occasionally a loss of initiative and interest in life. Not infrequently they report some sweating spells mostly in the head and upper chest with occasional outright hot flashes. Reluctantly they will tell me of their decreased or absent sex drive and problems with the firmness, persistence and frequency of erections.
      Recently researchers presenting at the Endocrine Society’s annual meeting reported that men with low testosterone levels have an increased risk of dying from a variety of causes. They followed 2,000 men aged 20 to 79. Men with low testosterone were more likely to be obese, and had a greater prevalence of diabetes and high blood pressure, compared to men with higher levels. The scientists reported that men with low testosterone levels had more than 2.5 times greater risk of dying during the next 10 years compared to men with higher testosterone levels. This difference was not explained by age, smoking, alcohol intake, level of physical activity or increased waist circumference (a risk factor for diabetes and heart disease). When the researchers looked at death from specific causes, low testosterone predicted an increased risk of death due to cardiovascular disease and cancer.
      I had a long talk with Joe in the office and he agreed to measure his testosterone and free testosterone levels. It’s a simple blood test and results are usually back in a week. I sometimes also measure the level of the sex hormone binding protein, estrogen levels and pituitary hormones. Occasionally it is helpful to measure 24-hour urine hormone levels to determine not only the amounts of the hormones, but how they are being metabolized. Testosterone becomes increasingly sensitive to two enzymes that metabolize it into byproducts that have consequences for men. The 5 alpha-reductase enzyme produces dihydrotestosterone, the hormone behind balding and prostate enlargement. The aromatase enzyme turns testosterone into estradiol, a classic female hormone that causes growth of men’s breasts and an increased cancer risk for men.
      Men don’t need to accept andropause – and the low libido, weight gain, insomnia and muscle loss that accompanies it when there is effective treatment available. For Joe, that meant hormone replacement with testosterone. I don’t often use oral replacement because the pills can cause liver irritation and enzyme elevations. Rather, I most often prescribe testosterone administered as a liposomal gel applied to the skin or by injection in the muscle. A longer acting implant is also available.
      One of the things I have been most surprised about is the frequency with which men with type 2 diabetes have low testosterone in their blood. They are more than twice as likely to have deficient levels. Finding and correcting a low testosterone often results in substantial improvement in their diabetes as well. In Europe, testosterone is routinely used to treat diabetes in men. It improves the sensitivity to insulin and results in lower blood sugar levels.
      It’s been a couple of months now since Joe was in. He came back as requested for routine follow up tests of his prostate and hormone levels. Joe is very pleased. He has much more energy, feels stronger and more confident. He thinks his memory is better and he hasn’t forgotten to bring flowers home to his wife. His wife is happy too since he’s more like his old self (no further comment needed!).

Subscribe today!