Understanding the male version of menopause
As men age, they experience decreased sexual function, declining mental and physical abilities, and greater psychological problems. These are all indications of andropause, the male menopause. Many men may present themselves late for medical treatment, as the onset of andropause may be quite insidious. Also, the symptoms are rather vague, so many men are misled into thinking and accepting the symptoms as part of ageing.
However, studies have shown that a high proportion of men may be suffering from andropause symptoms of varying severity. The numbers will no doubt increase over the years as the population ages. With improved health care, men are living longer. They want to be able to enjoy their golden years and maintain a good quality of life. Greater awareness of andropause due to public education means that they will be more willing to get medical help. Changi General Hospital (CGH) in Singapore has set up its Andropause and Men's Health Clinic where men can screen for the condition and seek treatment.
What is andropause?
Let us first understand what menopause is. Menopause occurs when a woman stops menstruating. When this happens, her ovaries stop functioning — that is they stop producing eggs and the female hormone, oestrogen. The female hormone decreases suddenly, resulting in the symptoms typically experienced during menopause. The sexual organs in a man are the testes. As a man ages, his testes will produce less male hormone, or testosterone. When the testosterone drops below certain levels, he will suffer the symptoms of low testosterone, or andropause.
Andropause itself is not exactly menopause in men. For women, the oestrogen decline is severe and sudden during menopause whereas the testosterone decline is much more gradual for men. Many men do not notice the deterioration of their condition as the process is more drawn out. Moreover, the testes still produce sperm, albeit at a much lower level.
What are the symptoms of andropause?
Between the ages of 40 and 70, there is an annual decrease in the production of free testosterone of 1.2 per cent. Testosterone is the hormone that maintains sexual function in a man. including erectile function (potency) and libido, and also helps maintain lean-muscle mass and bone mass.
So, a low level of this hormone may lead to impotence and a decreased sexual drive. The man may also lack the motivation to work and face the world, and cannot remember things as well as before. He begins to notice a spare tyre, often referred to as the 'beer belly', resulting from more fat deposits around the waist. His strength dips with the softening muscles, and his bone mass decreases in a condition termed osteoporosis, which puts him at a higher risk for bone fracture.
How can andropause be treated?
The treatment for andropause is androgen replacement therapy. As the effects of andropause are due to the lack of testosterone, various preparations of the hormone can be taken as a supplement. There are various methods of hormone replacement. One of the most popular is taking testosterone capsules. Another popular method is by injection. Other forms of replacement, which may be available soon, include gels and patches. The length of time required for replacement varies. Medication can continue as long as the man finds that it helps improve his symptoms.
The andropause challenge
Many men may present themselves late for medical treatment as the symptoms are rather vague. Men usually do not like to see a doctor if they do not have any obvious medical problems. So a clinic specialising in andropause will encourage men to seek consultation.
If a man has symptoms relating to andropause, it does not necessarily mean that he is suffering from the condition. At CGH's Andropause and Men's Health Clinic, certain blood tests are performed to check his hormonal levels before diagnosing him. For example, although many men have erectile dysfunction with age, the problem is not always due to andropause. It may stem from the degeneration of tissues in the penis which can also be diagnosed and treated at the clinic.
Andropause is a natural process and a man can help himself by developing a healthy lifestyle in order to delay its onset. He should have a well-balanced diet, with limits on sugar, fat and salt. He should not smoke and drink excessively. Regular exercise will also help.