Man-O-Pause: Biological changes with aging strike men as well

Sunday, November 22, 2009

Psychotherapist Jed Diamond started noticing the middle-aged guys around him were getting cranky.

"I'd been doing counseling for a number of years," he says from his home in Northern California, "and what I was seeing in the clients I was working with - as well as some of my friends - was a real change of life that was every bit as significant and hormonally based as what women were going through when they experienced menopause. But I was seeing it in men!"

Then, Dr. Diamond's wife weighed in with her own observation.

"She said, 'You know what? You're having the same emotional ups and downs and physical changes as I'm experiencing. I don't know if there's any such thing as male menopause, but you've got it!'"

That was in the mid-'90s. Today, after years of research, Dr. Diamond has published several books on the subject, including the best-selling "Male Menopause," "Surviving Male Menopause" and "The Irritable Male Syndrome."

There are four major causes of what Diamond refers to as "the change" for men, which typically occurs between ages 40 to 55 and older: fluctuations in brain biochemistry (which is often related to diet), stress, the changing (and sometimes confusing) role of men in today's society and a natural drop in testosterone levels.

Medical doctors frequently use the term "andropause" or "hypogonadism" to describe these age-related hormonal changes in men.

Dr. Donald Hatton, Lawrence internist, sees it often in his practice but says the condition can be challenging to diagnose.

"It's very difficult to know when and if it's coming," explains Hatton, "because many of the symptoms - muscle weakness, irritability, not sleeping well and sexual dysfunction - all have a multitude of causes rather than just a lowering of the serum testosterone.

"Plus, the other difficulty is, if you look at serum testosterones, the range of normal is very large."

Normal testosterone levels range between the low 200s to 900 ng/dL (nanograms per deciliter) and while the numbers tend to decrease as a man ages, the point at which a man will start having symptoms is impossible to predict.

"Many people will have lower serum testosterones and not have any symptoms at all," Hatton points out. "That's because they eat well, aren't overweight. They're not diabetic and not on a multitude of medications. They don't drink alcohol a great deal; they're certain to get their sleep. They have a good relationship with their partner or their wife. They exercise and take care of themselves. Those people seem to do quite well even though they have little or, in fact, many times, no testosterone."

In other men, low levels can cause weakness in the muscles, moodiness and sexual problems like low libido and impotence. And, as in women, osteoporosis (bone loss) is a real concern.

Treatment options

A complete physical examination can help determine the problem and its proper treatment.

"Male menopause, for the most part, is an exclusion diagnosis. You want to be certain there's not some other endocrine problem, or some that is making the testosterone low. You have to be certain the pituitary gland is working properly and that there's not an organic problem with their testosterone-making organs, that they haven't had some injury to their testicles, for instance."

Once an accurate diagnosis has been made, treatment options will vary.

Hatton says, "Before you start hormone replacement therapy, you have to ask 'does this individual have an increased risk for prostate cancer?' because testosterone is the food that feeds prostate cancer."

"If everything else is OK, generally what we do is offer testosterone replacement to make the patient feel better - better muscles, better bones - then, at the same time, offer them a medication to help with sexual function, if that is part of the syndrome."

Brad Grant of King Pharmacy, who provides bio-identical hormone replacements to women and men, says andropause is a growing trend.

"It's something that's beginning to be more prominent because of the aging population, the increase in longevity and, of course, all the baby boomers," he says. "You're seeing many more men that are being affected by this these days."

Facing the stigma

Being affected, however, doesn't necessarily mean men will seek treatment for what some consider an embarrassing problem, or just an inevitable result of aging.

"We see some men coming in" notes Grant. "I think usually it's their wives who ask for them. Men will sit there and say, 'Well, I'm not as energetic. I just don't feel like doing the things I normally do; I don't have any sex drive.' And they shrug it off and think it's just part of the aging process because it comes on so gradually. They don't realize there is something they can do about it. Women are much more proactive about things like that."

Dr. Diamond agrees and reveals it's usually the woman who prompts a man to take action.

"If she approaches him in a way that makes him more receptive - even if he's in denial - then over time she can get through to him," suggests Dr. Diamond. "Once she does, I've found that men are very engaged at wanting to make things better because they don't like being grouchy or irritable. And they're hungry for a way that they can make changes but still feel manly, with their integrity intact."