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Condition - Male Menopause, reality or myth?

By Jackie Newson BSc (Hons)

For many years it has been recognised and documented that women suffer from the menopause. Although men undoubtedly experience changes due to a reduction in androgen levels, there is still some controversy as to whether it can be termed a male menopause or andropause. Naming it appropriately has brought confusion, and not doing so brings scepticism about its medical relevance and therefore diagnosis and treatment. Ongoing use of the term ‘male menopause’ became popular due to the similarity in symptoms between men and women and appears to have stuck. The term ‘male climacteric’ has been used in the past and may be more apt as it suggests a decline rather than a sudden drop in the male sex hormones that may bring about changes.

During the 1950’s and 1960’s much was written in the popular press about the male menopause, but any medical discussion surrounding this topic appeared to vanish in the 1950’s. Some believe that during this era men’s dominant masculine role differentiated them from women. Because of this division in traditional roles, men and their male doctors could not accept that something, which appeared to be primarily a female condition, could also affect them. Symptoms that could be put down to stress fitted in much better with the idea of the hardworking breadwinning male and alleviated middle aged mens’ fears of being prematurely pensioned off!

The differences between male and female hormones

Testosterone is formed in the ovaries, testes and adrenal glands of both men and women and is the primary source of libido. It is also associated with aggressive behaviour and whilst women and men both start out in life with low levels of testosterone and oestrogen, changes take place at puberty meaning that women have higher levels of oestrogen and men have more testosterone. Androgens such as testosterone decline with age and in the case of men, they are left with higher oestrogen levels than women of the same age.

Where women are concerned; the menopause is associated with a fairly abrupt decline in female hormones around the ages of 46 to 52, whilst at the same time ovulation ceases. In the case of men, their testosterone levels usually start to decline in mid-life decreasing until the end of life, their fertility however is not affected. It is this gradual decline that gives rise to the question of whether it is really appropriate to make a comparison with the female menopause.

In some instances men experience a more significant hormonal decline than others. Research carried out in 1999 by Philip and Tan, revealed that smoking appeared to be the only consistent factor in this early onset of hormonal withdrawal. The same results emerged in relation to women who smoked and experienced early menopause.

Effects of hormone decline in men

There appears to be a number of conditions that are associated with decreased testosterone levels. These include coronary atherosclerosis, diabetes mellitus and sleep apnoea syndrome. A reduction in androgen levels produces symptoms that can be placed into three categories. These include physical, psychological and sexual.

Physical

Physical symptoms include a deterioration in muscle strength, lack of energy, disturbed sleep, memory loss, bodily hair loss, weight gain and frequent urination.

Psychological

The psychological symptoms include depression, anxiety, low self-confidence, irritability, poor concentration and indecisiveness.

Sexual

Sexual symptoms range from lack of interest in sex to erectile dysfunction, poor libido and impotence. These symptoms cause the most distress in many older men, often leading them to consult their GP for medical advice.

Treatment options

The female menopause has been given a great deal of recognition by the pharmaceutical industry and it has responded by producing a proliferation of drugs. Treatment for men however, seems to be primarily focussed on androgen therapy. Although this is currently available, it is not suitable for all men as testosterone levels vary greatly, with some men having only a moderate decrease in their plasma testosterone levels. Indeed there appears to be some risk involved as androgen substitution may have adverse effects on the liver, prostate health, heart disease, sleep disorders and emotional behaviours. On the positive side, some studies suggest that elderly males who are depressed appear to have the lowest testosterone levels, so using androgen therapy may prove beneficial where conventional antidepressants have failed.

What about a natural approach?

L-Arginine

Arginine is an amino acid and makes nitric oxide, which naturally relaxes blood vessels, thereby helping maintain blood flow to the sexual organs. In 2004 a review was carried out investigating nutrients and botanicals recommended for erectile dysfunction. Arginine emerged as being a naturally occurring compound that may be useful for penile erection(1). Dietary L-arginine can be found easily in our food supply. Legumes, whole grains and nuts can provide several grams per day if eaten in moderate to large amounts. However, for those who have dietary restrictions and are unable to include these foods in their diet, concentrated amounts can be taken in supplement form.

Ginkgo Biloba

Ginkgo biloba also helps widen blood vessels promoting healthy blood flow, making it a useful herb to include in the diet for men suffering from erectile dysfunction. A trial on 60 patients not responding to standard medication, using ginkgo extract for 12 to 18 months found that fifty percent had regained their potency(2). Ginkgo leaves can be used as an infusion for tea, or taken in supplement form.

Korean Red Ginseng

Korean red ginseng is another herb thought to increase the concentration of nitric oxide. An encouraging study carried out in 1995 found that a group of men given Korean red ginseng experienced positive changes in libido, satisfaction and penile girth and rigidity. Sixty percent of this group found a therapeutic benefit compared to just 30% in the other two placebo and drug groups(3). Korean red ginseng has also been used traditionally in Chinese medicine to raise energy levels and is often used alongside B vitamins in supplement formulas for this purpose.

The jury is out as to whether men have a female equivalent ‘andropause’. Regardless of this, the symptoms they experience are no less distressing than those women suffer during the menopause and should be given equal importance when considering treatment options. 


Article References

Mckay D (2004). Nutrients and botanicals for erectile dysfunction: examining the evidence. A Journal of Clinical Therapeutic. 9, 1, 4–16. [Abstract] 2. Aachen F R, Doris R, Friedrich J et al (1989). Ginkgo biloba extract in therapy for erectile dysfunction. Journal Urology. 141, 188A. 3. Philip P S, Tan R S (1999). Perceptions and risk factors for andropause. Arch Androl. 43, 97–103.

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