Until recently no one talked much about low testosterone in men or what’s come to be known as “male menopause.” Now, with all the hype on TV talk shows and celebrity news, men want to know whether “male menopause” is fact or fiction. The truth is, there’s no simple answer.
In women, hormone changes come on rapidly with a sudden reduction in estrogen, often accompanied by mood swings, hot flashes and other symptoms. Some time in their 40s or 50s, all women go through menopause.
In men, hormone levels change gradually, if at all. Research has shown that a third of men over age 45 will have low testosterone. In general, testosterone levels vary greatly among men, and some men never experience “male menopause.”
Testosterone helps regulate so much of the body’s chemistry that when its levels fall, many organ systems are affected. Low testosterone is linked to bone loss and possibly heart disease. Men with low testosterone may gain weight around the abdomen and lose muscle tone in their arms and legs. Many men feel fatigued and even depressed. Some don’t sleep well and have trouble concentrating. But it’s the loss of libido that most often prompts men to seek treatment. They don’t have the sex drive they once did. And that’s not the way they want to feel.
Low testosterone can be diagnosed with a simple blood test. This is usually performed in the morning to get an accurate measure because testosterone levels fluctuate throughout the day.
Often the hormone level alone doesn’t fully account for the symptoms. Some men continue to produce plenty of testosterone as they age but they simply don’t respond to it as well as they once did.
Doctors will also rule out any underlying medical condition that could account for lower hormone levels, such as a pituitary tumor, thyroid disease, alcoholism or liver disease. If a patient has age-related low testosterone, it’s time to talk about treatment.
Testosterone is not given to men who want to have children because it can interfere with sperm production and cause infertility. Other than the risk of infertility, the risks of hormone treatment are minimal. Doctors monitor red blood cell count, to make sure it doesn’t get too high. The hormone may cause skin irritation or breast tenderness. Some studies have linked it to prostate cancer, but so far there’s no proof. Any man considering testosterone treatment should be screened for prostate cancer and hormone therapy should not be used in men diagnosed with untreated prostate cancer.
Testosterone is often prescribed as a cream that’s absorbed through the skin. Patients rub it on their arm, shoulder or abdomen once a day. Injections are also available and are given every two to three weeks. There’s no oral form of the drug approved in the U.S.
With testosterone treatment, most patients report immediate improvement in the way they feel. Their sex drive returns. They feel energetic again. And their mood improves.
It is important to remember that not all men develop low testosterone. There may be other explanations for low energy, depression and the growing paunch. But for men who do suffer from low testosterone there’s plenty of truth in the phrase “male menopause.”