MALE MENOPAUSE : THE ANDROPAUSE

Dr.S.M.Bose

It may come as a surprise and may be as a rude shock to the male chauvinists that like their female counterparts, males also attain menopause. In males it is actually not Menopause, which literally means pause or cessation of menstruation; it is known as Andropause or Viropause or Male Climacteric and this physiological state is similar to menopause in females.

Andropause was conceptually described in medical literature about seventy years earlier but realization seems to be coming now. Longevity of life has increased, life style is changing fast and the desire to live better and happier in all aspects have drawn the attention of medical personnel to look into this aspect of aging male population.
By the age of 50 to 55 years, a male person may start feeling the first sign to suggest the onset of Andropause; of course, neither all get it nor all start at the same age and obviously the severity and perception also varies in individuals. In contrast to females where cessation of menstruation is the obvious signal for this physiological change, in males there is no definite signpost and that defies easy recognition.

The physiological ( natural ) reason for this transformation is the decreased levels of sex hormone, oestrogen in females and testosterone ( He – hormone ) in males. The decrease in sex hormones can be also due to diseases – pathological causes, but here we shall restrict ourselves to normal aging process. As the man reaches the age of 50 years ( it can vary a lot, can be less or more ) , his testosterone level starts declining ; again the degree of decline is not the same in all men population. This decline is gradual and may take years together to manifest its full effect. This decrease in testosterone level and its manifestation resulting in Andropause varies with the physiological and psychological state of the person, presence of any disease or infection, intake of alcohol or medicines, physical stress due to injury or any major operation.

Andropause may cause a number of problems, the main ones being:

  1. Decreased libido resulting in lack of interest in sexual activities.
  2. Loss of muscle mass leading to decreased muscle power. You must have heard of athletes , weight lifters taking drugs ( testosterone being one of them ) to strengthen their muscle power and decreased testosterone level weakens the muscle power.
  3. Obesity , commonly resulting in paunch , is seen after the middle age and it is not only due to lack of activity but also because of deficient hormone also.
  4. Psychological and behavioural changes so that the interpersonal and social relations change. Loss of memory and concentration, delayed reflexes, lack of alertness ; nervousness and irritability, sleep disturbances, indecisiveness , loss of interest and self-confidence all are supposed to be aging problems and these to some extent are due to decreased levels of hormone. In short it may be said that an active person goes into a shell.
  5. Low testosterone level results in decreased bone density , 15 to 20% , and this gives rise to Osteoporosis or Weakness of bones. This results in low back pain, fractures after trivial injuries – like hip fracture after a fall.
  6. Circulation problems – Preliminary research has shown that like women, men are also prone to develop atherosclerosis due to diminished testosterone levels, but it requires to be clearly documented.

Ignorance and lack of awareness about andropause results in nondiagnosis of the condition in a significant number of cases. The awareness for andropause is very poor both amongst common men and also amongst physicians ; resulting in poor and delayed diagnosis. The symptoms are very vague. Moreover the man gets this at such a stage when retirement, psychological stress, aging problems etc. are present and the symptoms of andropause are taken as results of changed life style. Neither the patient nor his relations or his family physician take him seriously and he is just prescribed a few medicines – vitamins, antidepressants , mood elevators etc. and advised to devote his time in meditation and prayers. On many occasions the patient may be labeled a psychological problem and referred to a psychiatrist., the patient hardly ever follows the advice and the problem persists .

How is Male Menopause produced?

Testosterone is the male sex hormone , produced by testis and the adrenal glands. Testosterone level keeps on increasing from puberty and starts declining from the age of 30 years , almost 10% per decade. This decline may be very fast and steep in some resulting in marked andropausal symptoms whereas in some it may not be that bad. It is estimated that approximately 30% of the men folks in their fifties develop low levels of testosterone resulting in marked manifestations of andropause.

Testosterone acts on many organs of the body, male sex organs , liver, bone, muscles, brain, kidney etc. It has varied functions, some of the important ones being – growth of secondary sexual organs and characters, sexual behaviour including libido, protein and carbohydrate metabolism, bone formation, and production of blood cells from the bone marrow.

Low level of testosterone brings about a few changes in the person _ diminished muscle power, decreased libido and sexual activity, behavioural changes, weakening of bones ( Osteoporosis ) resulting in backache and fractures, indecisiveness , loss of hair, obesity particularly in the mid part of the body. Decrease in testosterone level is also supposed to increase the risk of heart problems, the most important being atherosclerosis – the narrowing and hardening of the blood vessels.

All these features are commonly seen in old age and are linked to aging. It is not widely recognized that in a large percentage of cases this is due to decreased levels of testosterone and this can be kept under control by rationale replacement treatment.

Diagnosis :

As already mentioned earlier, andropause is not a newly discovered problem but its impact has been recognized recently. New and more sensitive blood testing methods are available now for the estimation of bioavailable testosterone resulting in accurate diagnosis of the condition.

Treatment :

The treatment is HRT – hormone replacement treatment , and this is done by prescribing testosterone , usually in the dose of 40 mgs per day. The drug is available in the form of oral capsules, injections or skin patches. The effect is usually noticed after 3 to 6 weeks and the replacement therapy should be continued for very long time.
The medicine should be started only after a careful medical check up to rule out the presence of any other medical problem. Blood testosterone level should be also determined and the medicine is only given if the level is on the lower side.

Testosterone should not be used by the persons who have or had breast cancer or prostatic cancer. It is also not prescribed to the persons who want to father a child as testosterone may cause infertility. Similarly the presence of any of the following conditions should caution a person and the medical specialist would take decision after evaluating the details of the ailment with the help of investigations :

  • Heart or circulation problem
  • Enlarged prostate
  • Kidney disease
  • Diabetes Mellitus
  • Liver disease
  • Edema or retention of fluid in the extremities
  • History of allergy following intake of testosterone or androgens
  • A bed ridden person
  • A person who is on anticoagulants – blood thinning medicine

Science is progressing very fast and so also the medical science. Present day medical practice is committed to help a person, not necessarily to treat the diseases only but to make the life more comfortable and enjoyable. Treatment of male menopause or andropause is an effort in this direction, it has been realized late as compared to female menopause. But now effort is needed on the part of the affected persons to do away with shyness and consult their doctors and the medical doctors should take initiative not only to counsel their patients but to treat the person who may not be harbouring a disease in the true sense but who desires and deserves a happier and comfortable life.

  1. Effects of Andropause:
  2. Loss of muscle mass and muscle power
  3. Psycho-social behavioural changes
  4. Decreased bone density resulting in backache and fractures Treatment

Effects of andropause can be kept under control by judicious use of Testosterone –the male hormones; under the supervision of a doctor.