Male menopause: is it a fact or fiction?

Dr Pius Musau explores the medical controversy of the so-called men’s midlife crisis.Until recently, male menopause was rarely talked about. Now, the so-called "male menopause" has many men rushing to their doctors to treat symptoms they believe may be related to low levels of testosterone — one of the signs of the age—related process. The concept behind male menopause is that the decline in testosterone levels that occurs as men age may produce potentially treatable set of symptoms. Male menopause is also referred to as low-testosterone, andropause or medically late-onset hypogonadism.Some medics, however, argue that comparing the analogy to the process in women, with some even using terminology like "male Pre—Menstrual Syndrome" is going too far. While it is true that testosterone levels decline as a man ages, the drop in female hormones occurs at a much greater extent. But while the symptoms in women are clearly understood, those of male menopause are not. Although sexual dysfunction is a common complaint, there are other non-specific symptoms such as depression, mood changes, weight gain or fatigue. These have been interpreted by some as symptoms of male mid-life change.Despite the fact that many doctors treat mid-life symptoms in men with testosterone hormone therapy, the value of this therapy still remains controversial. This is because there are few long-term studies about the effects or benefits of testosterone supplementation.But still, prescriptions for testosterone are on the rise, although doctors are yet to agree on whether this therapy should be recommended.Women are not the only ones who suffer the effects of changing hormones increasingly, doctors are noticing that their male patients are reporting similar symptoms to those that women experience during peri-menopause and menopause.The medical community is currently debating whether or not men go through a well-defined menopause. As of now, doctors say that male patients receiving testosterone hormone therapy report relief of some of the symptoms associated with male menopause.Since men do not go through a well-defined menopause, some doctors refer to this problem as androgen, that is testosterone decline in an ageing male. Age causes men to experience a decline in the production testosterone, but some diseases like diabetes can trigger this problem. Some men also experience symptoms such as fatigue, weakness, depression and sexual problems. The relationship of these symptoms to the decreased testosterone levels is still controversial.Unlike menopause in women, when hormone production stops completely, testosterone decline in men is a slower process. The testes, unlike the ovaries, do not run out of the substance it needs to make testosterone. A healthy male may be able to make sperm well into his 80s or longer.However, as a result of disease, subtle changes in the function of the testes may occur as early as 45 to 50 years of age and more dramatically after the age of 70 in some men.To diagnose male menopause, the doctor performs a physical exam and asks about a patient’s symptoms in order to rule out any underlying medical problems.A series of blood tests, which may include examining the hormone and blood testosterone level will be done. If your testosterone levels are low, a replacement therapy may help relieve symptoms such as decreased libido, depression, and fatigue. But, unlike the hormone replacement therapy in women, the male’s has some potential risks and side effects; it may worsen prostate cancer.If your loved one is considering androgen replacement therapy, talk to a doctor to learn more. Your doctor may also recommend certain lifestyle changes, such as a new diet, exercise programme or medications, such as an anti-depressant to relieve some of the symptoms of male menopause.-Dr Pius Musau, is a consultant urologist at Moi Teaching and Referral Hospital, Eldoret

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