Leadership (Abuja)

8 December 2012

Nigeria: How Real is the Male Menopause?

Most people are aware of the term menopause - a time in a woman's life when her menstruation (period) eventually stops. But not many know that males also go through a form of menopause, known as andropause, a similar phenomenon with identical symptoms. Raliat Ahmed-YUSUF explains.

The word menopause is more used to refer to the time when the menstruation diminishes or ceases in the life of a woman, and this is usually when the woman has clocked between the ages of 45 and 50.

Menopause is a condition most often associated with women. It occurs in a woman when she ceases to menstruate and can no longer get pregnant. Men experience a different type of "menopause" called andropause - a condition that is associated with the decrease in the male hormones testosterone with age.

It usually occurs between the ages of 45 and 60, but sometimes as early as age 30. Unlike women, men can continue to father children, but the production of the male sex hormone (testosterone) diminishes gradually after age 40.

Andropause, the male equivalent of female menopause, is generally characterised by a decline in sexuality and energy due to the decreasing level of the male hormones. Testosterone is the hormone that is responsible for deep voices in men, sexual development in the male infant, bone and muscle growth in adult males, and facial and body hair patterns found in males.

As men get older, the level of testosterone in their body reduces, and the production of sperms gradually decreases, making them experience physical and psychological symptoms.

Andropause was first described medically in the 1940s, but was not accepted by the medical fraternity until recently. While the causes of male menopause have not been fully researched, studies have shown that some factors such as hormone deficiencies, excessive alcohol consumption, obesity, smoking, hypertension, prescription and non-prescription medications, and psychological problems, especially mid-life depression, are known to contribute to this condition, also described as puberty in reverse.

Andropause is different from the menopause women experience. In menopause, the production of female hormone drops suddenly, but in men, there's a gradual decline in hormone levels.

According to medical experts, from the age of 40, testosterone levels in men usually begin to drop about one per cent a year. The reduction is rarely noticeable in men younger than 60, but by the time they reach their 80s, about half have low testosterone. In a young agile man, the testosterone levels exceeding 1,000 nanograms per deciliter (ng/dl), while in an old man such as an 80-year-old, the average testosterone level is 200ng/dl.

Diminished sex drive, reduced muscle bulk and strength, night sweats, infertility, fewer spontaneous erections, depression, loss of body hair, shrunken testes, memory loss, sleep problems, increased body fat and anemia, among others, are some of the symptoms of low testosterone, which eventually leads to andropause.

Below are what to expect and what you can do about them, according to Mayo Clinic research:

Understanding male hormones over time:

Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood, about one per cent a year after age 30 on average. By about age 70, the decrease in a man's testosterone level can be as much as 50 per cent.

Recognising low testosterone levels:

Some men have a lower than normal testosterone level without signs or symptoms. For others, low testosterone might cause:

• Changes in sexual function. This might include erectile dysfunction, reduced sexual desire, fewer spontaneous erections, such as during sleep, and infertility. Your testes might become smaller as well.

• Changes in sleep patterns. Sometimes, low testosterone causes sleep disturbances, such as insomnia, or increased sleepiness.

• Physical changes. Various physical changes are possible, including increased body fat; reduced muscle bulk, strength and endurance; and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Rarely, you might experience hot flashes and have less energy.

• Emotional changes. Low testosterone might contribute to a decrease in motivation or self-confidence. You might feel sad or depressed, or have trouble concentrating or remembering things. It's important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level or a reduction in the bioavailability of testosterone.

Here are some best methods of how to handle the problem:

Feeling your best. If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options. You can't boost your natural testosterone production, but these steps might help:

• Be honest with your doctor. Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms - from medication side effects to erectile dysfunction and other sexual issues.

• Make healthy lifestyle choices. Eat a healthy diet and include physical activity in your daily routine. Healthy lifestyle choices will help you maintain your strength, energy and lean muscle mass. Regular physical activity can even improve your mood and promote better sleep.

• Seek help if you feel down. Depression in men doesn't always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, using illicit drugs or seeking thrills from risky activities.

• Be wary of herbal supplements. Herbal supplements haven't been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.

Treating aging-related low testosterone with testosterone replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however, particularly older men, the benefits aren't clear.

The risks are a concern as well. Testosterone replacement therapy might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the pros and cons.

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