30 November 2017
It is often called the ‘Manopause’ - a term used to describe the changes in hormone production that men experience as they age which can cause similar symptoms to those experienced by women going through the menopause.
The effects can be profound, with hormone level changes affecting physical and mental health as well as sex drive. It is estimated that the condition could affect up to 12% of males over 40 according to Dr Jeff Foster, a private GP who holds regular clinics at Spire Parkway Hospital.
A lack of medical answers or a reluctance to seek help has meant that in the past men have had to live with ‘age-related slowdown’ - almost accepting it as a part of getting older.
But Dr Foster said: “It is easy for symptoms to be attributed to the stress of modern life, which is why the male menopause has often been dismissed. However, medical help is available and men are now being encouraged to bring their problems into the open.
“The main treatment is Testosterone Replacement Therapy (TRT) where the aim is to return a patient’s testosterone to a normal level. As the number of men with obesity, type 2 diabetes, and other hormone-suppressing conditions increase, it may be time to stop thinking of testosterone deficiency as a normal consequence of ageing in males.”
Here Dr Foster looks into causes and possible remedies as he answers some often-asked questions.
Q: What are the most common symptoms of male menopause?
A: The immediate tell-tale signs are low libido resulting in a decreased sex drive. Something men find very difficult to talk about. However, other indications include a loss of muscle mass, obesity, and tiredness.
Q: What about some of the ‘not-so-common’ symptoms?
A: Depression, irritability, poor concentration and hot flushes – sometimes men write these off as an age thing but they need to be aware all could point to the male menopause. I would like to see a campaign asking partners to be on the lookout for symptoms – often a partner will spot these changes before the actual sufferer!
Q: What are the main causes of male menopause?
A: Obesity, type 2 diabetes, hypertension, hyperlipidaemia, asthma, chronic obstructive pulmonary disease, liver disease, obstructive sleep apnoea, renal disease, hypothyroidism, use of opiates (codeine or morphine), cannabis, steroids, alcohol excess, potassium sparing diuretics.
Q: At what age can men be affected?
A: Any adult male can develop the condition but risk does increase with age. However, when I say risk increases with age I must stress that it is not because of age! There are lifestyle changes you can make to prevent or delay the onset.
Q: What kind of lifestyle changes will help keep the condition at bay?
A: Well the good news is one of the best ways of keeping testosterone levels up is more sex! Sex actually creates testosterone in the body so regular sex is a great way to keep levels normal.
Watching your weight is another must – obesity is a big trigger as is too much alcohol and over-use of prescribed medicines. Basically, a healthy diet, a reduction of alcohol and stopping smoking is going to help you in all aspects of your life not just in testosterone production! It is also important to get more than four hours sleep per night. Getting plenty of exercise is a good idea – but not too much as excessive exercise actually decreases testosterone. However, don’t start worrying about doing too much just yet – we really are talking about ‘excessive’ exercise if it is to have a negative effect.
Q: What medical treatments are available?
A: The three basic ways to increase testosterone are gels, oral tablets, or injections. Your GP will select the form and the dosage. As with most medicines it is important to stick with prescription instructions.
Q: Would someone in their mid-twenties be treated in a similar way to someone in their mid-forties?
A: Basic principles are the same regardless of age, but as age increases co-morbities (obesity, diabetes, organ disease etc) tend to impact on testosterone levels, meaning that someone in their 20s is less likely to be affected than someone in their 50s. However, once the symptoms are identified then basic testosterone replacement therapy is the same for all men, whatever their age.
Q: Are treatment outcomes improved if symptoms are diagnosed as early as possible?
A: Yes, interest in sex may improve in about three weeks, but true changes in ejaculation and erection can take as long as six months. Depression and mood should improve in the first month but improvements in metabolism, muscles mass and decreased obesity can take much longer. Therefore all patients on a testosterone replacement trial should be on for a minimum of six months.
Q: To what extent can symptoms be reversed or completely cured?
A: Most patients can be ‘cured’ completely but they need to be aware that it is often a long-term treatment.
Q: How quickly can the symptoms be dealt with?
A: Once a consultation is done and the blood tests completed treatment can start right away so turnaround time is usually about two to three weeks for all tests.
Q: Could the symptoms of male menopause be masking other, possible even more serious conditions?
A: It is often the other way around. Because many patients present with tiredness, fatigue, or feeling ‘low’ we do a standard ‘tired all the time’ screening which looks for anaemia, diabetes, thyroid disease, inflammatory diseases, renal and liver disease, and coeliac disease. Unfortunately the ‘standardised screening’ doesn’t include testing for testosterone levels - even though 25% of type 2 diabetics have low testosterone.