Updated 21 July 2014

Male menopause: more fact than myth

Research indicates that men also go through a difficult, stressful time in middle age; which again raises the question - does male menopause exist? Our experts claim it does.


Men cringe at the thought and many scoff at the idea that men go through a form of menopause. Yet more and more research is pointing to the fact men may indeed go through a "change of life".

Age-related hormonal changes appear to have just as much of a health impact on men as they do in women. So why does the concept of andropause (the "male menopause") still appear to be taboo?

The answer, according to Professor Mohamed Haffejee, head of Urology at the University of the Witwatersrand, is quite simple: men just don't take it seriously. They also don't know what they're looking for.

"In women, the changes that come with menopause are sudden, but with men they're gradual," he said. Men just assume they're seeing the inevitable consequences of the passage of time.

The science behind male menopause

Male menopause, also referred to as androgen decline in the ageing male (ADAM), andropause, late-onset hypogonadism (LOH), or testosterone deficiency syndrome (TDS), is when the levels of the sex hormone testosterone start declining.

Men experience a gradual decline in the production of the testosterone from their late-30s onwards. This may pose no problems, but where it does, and if the symptoms are recognised in time and the appropriate medical support is given, it's entirely treatable.

Recognising the symptoms is the challenge. They're of a subtle and unsurprising nature, but they can lead to life-threatening spin-offs, such as cancer and heart disease. With age, and a decrease in testosterone, there is an increase in a number of risk factors, like stress, obesity, hypertension and diabetes.

So which comes first: low testosterone or the risk factors? Does one lead to the other or do they occur separately and then exacerbate each other? Haffejee explains: "Obesity lowers your testosterone levels and a low testosterone is associated with obesity. It's the same with diabetes. It would be safe to say that each risk factor compounds the next and that each risk factor needs to be addressed on its own merit."

Symptoms of TDS include:

  • A lack of energy and vitality
  • Loss of sexual desire or libido
  • A decrease in the quality of erections
  • Mood swings and depression.

Ignorance and denial can be deadly

"Men are not educated enough on this and are often in denial about their symptoms with the 'it will get better' attitude. This is one of the reasons the rates of 'self-inflicted' death such as cancer and heart disease, are much higher in men than women, and why men die prematurely," said Haffejee.

He added that generally men have short-term goals when it comes to their health, and unlike women, they don't see looking after their health as an investment. This, he said, was why a new approach towards men's healthcare was urgently needed.

It was with this in mind he urged women to take note of the changes in their partner and ensure they seek medical advice as soon as possible.

"Symptoms such as erectile dysfunction should be seen as an opportunity for the patient and doctor to undertake an overall health check rather than simply prescribe medications such as Viagra, Levitra or Cialis. While these medications may assist with the ED they do nothing to treat the potential underlying causes such as heart disease. Often the symptom of ED is a precursor to cardiovascular disease - it should thus be seen as an 'early warning'," he said.

And just in case the seriousness of the situation is not clear enough, he added that if the symptoms of ED are ignored, this will almost certainly result in one, if not more of the following:

  • Decreased life expectancy
  • Increased cardiovascular risk (including type 2 diabetes)
  • Poor lipid profile and obesity
  • Decreased bone density with increased risk of fractures
  • Overall decrease in quality of life issues such as decreased sex drive, sleep disturbances, lack of energy, poor concentration and goal directed activity, erectile dysfunction and loss of muscle mass.

Doctors agree – awareness is key

Dr Sindeep Bhana, physician and endocrinologist at Chris Hani Baragwanath Hospital, believes that part of this new approach should include an awareness of how chronic diseases such as diabetes and metabolic syndrome affect men. And more importantly, how this affects their testosterone levels and overall health.

"It may sound confusing, but each risk factor carries a number of other risk factors with it. For example erectile dysfunction (ED) puts men at risk of high cholesterol, diabetes, cardiovascular disease. And the longer the risk factors go untreated, the harder it will be to combat them," he said.

It appears it is a vicious cycle, and Bhana urged men to ask their doctors to test their testosterone levels.

"TDS can decrease sexual desire, affect erections and alter the body's composition; this affects the other organs in the body and therefore affects one's quality of life. But through a healthy diet, management of testosterone levels and exercise, risk factors can be reduced and prevented," he said.

How dangerous is LOH?

According to Bhana, it's likely that hypogonadism is a fundamental component of the metabolic syndrome.

"Testosterone treatment may not only treat hypogonadism, but may also have tremendous potential to slow or halt the progression from metabolic syndrome to overt diabetes or cardiovascular disease," he said.

And by default, all components of metabolic syndrome (hypertension, dyslipidemia, diabetes, obesity etc) are underlying conditions for erectile dysfunction. Thus, men should be alerted that if they wake up without morning erections they should have themselves checked out by their doctors immediately.

Bhana said that abdominal obesity is the number one risk factor in metabolic syndrome and testosterone deficiency syndrome is a proven risk factor for all the metabolic syndrome components according to most recent research.

"Many patients with metabolic syndrome are locked in a vicious circle: Abdominal fat tissue reduces testosterone, but testosterone reduces the fat tissue," he said.

Is testosterone treatment effective?

Healthy living is first prize. For some, though, testosterone treatment may be the only option.

"Testosterone treatment has received a lot of bad press recently because of its abuse by gym goers. An excess of testosterone has many nasty side-effects such as acne, weight-gain, aggression and hair loss. But since clinical trials all show long-acting testosterone has many benefits, in moderation it is an effective treatment," said Bhana.

So how does it actually work? Haffejee said testosterone preparations are available as tablets, gels, patches, pellets and injection.

"Currently available in South Africa we have the long-acting intramuscular injection which usually needs to be administered every three months. The gels are not readily available locally yet and the short-acting injectables are not ideal in that blood levels are not constant, and may result in supranormal levels which are responsible for largely preventable side effects which include mood swings including 'roid rage', acne and breast enlargement in men. Oral preparations need to be taken three times a day which makes compliance difficult," he said.

On the downside, men who still wish to have children are strongly advised not to undergo testosterone treatment. Sportsmen, took, should be wary: professional sports bodies ban any substance that raises competitors' testosterone levels.

"There are some sporting events which will allow you to declare that you are on the treatment for medical reasons, but this is still a grey area in the world of sport,' said Bhana.

The third major drawback is the price: it costs at between 5000 and R7 000 a year, and has to be motivated before medical aid will pay for it.

Sources: Professor Mohamed Haffejee (Head of Urology, University of Witwatersrand); Dr Sindeep Bhana (Physician / Endocrinologist at Chris Hani Baragwanath Hospital)

(Amy Henderson, Health24, June 2008)

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