Male menopause: Myth or reality?

Dr Mohan B A

Hormone changes are part of the natural aging process. Unlike female reproductive hormones, that decline dramatically after menopause, male sex hormones decrease gradually. This can lead to a clinical condition called late-onset hypogonadism in aging men, consisting of specific symptoms and low levels of testosterone in the blood. Some other terms commonly used to describe this condition are male menopause, andropause, testosterone deficiency, and androgen deficiency.

The decrease in the male hormone, testosterone level is gradual, around 0.5 % per year. The incidence of hypogonadism is reported to be 12 cases per 1,000 people per year. In men aged 40-79 years, the incidence of symptomatic hypogonadism varies between 2-6 %. It is more commonly seen in people having diabetes mellitus and obesity.

Symptoms

Specific symptoms that suggest low testosterone levels are:

• Erectile dysfunction
• Lower sexual desires /low libido
• Low mood/mood defl ection
• Decreased motivation
• Fatigue

Less specific symptoms include hot flushes, reduced frequency of intercourse, decreased sleep, decreased energy, concentration difficulties, and decreased physical strength. Severely low testosterone deficiency can also cause bone loss and osteoporosis.

Treatment:

Lifestyle changes

• A balanced diet and regular exercise/ physical activity.
• Weight reduction is the first step in the treatment of the symptoms. Strict dietary changes and regulated exercise regimens should be initiated under clinician guidance for weight loss.
• Bariatric surgery can be offered to men who are morbidly obese.
• Avoid substance abuse – tobacco and alcohol. Tobacco smoking has a direct causal effect on erectile dysfunction.

Detection of testosterone deficiency

Men with the above-mentioned symptoms should get a blood test to measure total testosterone and free testosterone in the morning hours (7 am to 11 am) in the fasting state. A low value needs to be confirmed with a repeat test after a week before planning treatment.

Concomitant diseases, drugs, and substances that can interfere with testosterone production should be checked and corrected.

(Dr Mohan BA is a urology and transplant surgery consultant at Fortis Hospitals.)