Have you heard about men suffering from Menopause ? Well its not menopause technically, but the guys version called Manopause or Androgen deficiency of the ageing male (ADAM) or Late Onset Hypogonadism (LOH). Are you suffering from it or do you someone who is down with Manopause ? How do you identify and how do you know ? Let's find out.
Male menopause: Myth or reality?
We have all heard of female menopause that is characterised by symptoms like hot flashes, mood swings and irregular dwindling periods. The reduction in sex hormone estrogen is help responsible for this medical condition in women. In men too the male hormone called Testosterone begins to fall steadily. A man's testosterone levels decline on average about 1% a year after age 40 leading to certain symptoms which are easy to identify.
Source: mayoclinic.org
Its very Evident ! Much more than Menopause
Andropause is characterised by a gradual decline in testosterone levels in aging men. Testosterone is a hormone that plays a crucial role in various bodily functions, including the maintenance of muscle mass, bone density, red blood cell production, and sexual function. While the decline in testosterone levels is a natural part of the aging process, the symptoms associated with andropause can be quite impactful. A decrease in vitality and sexual powers is something that a man can easily notice in himself. Awareness that "weakness with increasing age is not normal" is good enough to trigger a visit to a doctor.
Most men however neglect these non specific symptoms and continue being under the weather for years together. Detection is not so difficult. Its just a few questions an the level of Testosterone in blood that together determine the onset of Andropause or Manopause.
What are the symptoms of manopause?
The Adam Score says it all. The ADAM (Androgen Deficiency in Aging Males) questionnaire consists of 10 questions that help determine if a male patient suffers from androgen deficiency (low testosterone) or not.
1.Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased "enjoyment of life"?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noted a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?
If the answer to any of the first 7 questions is yes and you have low blood total Testosterone levels then you have Andropause. If your answer to any two of the three last questions (8-10) is yes then also you are likely to be suffering from this condition if the blood levels are low. Beginning about age 50, the prevalence of erectile dysfunction begins to increase exponentially from 5% of the adult male population to more than 50%by age 80 years.(Source: ncbi.nlm.nih.gov) Erectile Dysfunction is a major distressing symptoms that can force men to visit the clinics for low levels of Testosterone.
Low Testosterone can have effects on the Cognitive function (brain function), sex drive and the quality of life. Weight gain and decreased bone mineral density lead to weaker bones and increase chances of fractures.
What should you do about it ?
1. Consult a Healthcare Professional
2. Consider Hormone Replacement Therapy (HRT)
3. Lifestyle Changes
4. Dietary Choices
5. Exercise Regularly
6. Manage Stress
7. Stay Hydrated
8. Avoid Alcohol and Tobacco.
9. Discuss Medications
10. Emotional Support
11. Regular Check-ups
12. Educate Yourself
Can this be cured ? the real deal
Low testosterone can be easily managed with supplementation of Testosterone based on recommendation of the doctor. A few tests will initially be needed to ensure that you don't have a contraindication to starting supplementation. These tests include:
Hemogram or complete blood count
Liver function tests
Serum Prostate Specific Antigen (PSA) - a marker of prostate cancer
Cardiac Evaluation
If you don't have an absolute contraindication of starting Hormonal Replacement Therapy called Testosterone replacement Therapy or TRT, then the doctor can give you options for supplementation which may be in the form of:
Injections
Tablets
Testosterone Gels
Injections are the most reliable way of maintaining a steady level of Testosterone. After a loading dose, injections may be placed every 2 weeks or 2 months depending on the formulation.
Gels and tablets have to be used daily and are also effective albeit unreliable ways of boosting Testosterone as compliance has to be ensured. Gels may occasionally be transferred to the partner leading to symptoms of high testosterone in the partner.
Therapy is overall easy and monitoring is required through some physical checkups and laboratory tests.
Can I boost my testosterone levels naturally?
Yes there are ways and means to boost testosterone naturally if levels are low or borderline. The most important way is to cut down on the body fat as fat cells eat Testosterone through an enzyme called Aromatase.
The more fat you have the more of Aromatase you have. The job of aromatase is to convert Testosterone to female hormone Estrogen. Cutting down the fat is thus the most natural way to boost your male hormone.
Stress can reduce the androgen levels in the body. A relaxed lifestyle spiced up with adequate sexual activity can help you boost Testosterone naturally.
Sleeping adequately can be a boon to those with altered circadian rhythms and irregular Testosterone production.
What are the Potential side effects of HRT or Testosterone Replacement?
The side effects of Testosterone replacement therapy may include:
Headaches
Nausea
Leg cramps
Bloating
Indigestion
Breast discomfort
Testosterone may increase the chances of heart disease such as heart attack and uncontrolled heart failure, if adequate screening is not done before starting.
Manopause is lesser known but the dent it makes is far from evident. Most men don't know what manopause has done to them. Only friends and family can recognise the gradual apathy and loss of zest for living. Treatment is easy, first identify and then get on Testosterone replacement. Follow ups are simple as well. Unlike hormone replacement therapy in the ladies there aren't many side effects with Testosterone Replacement. If you know someone or are someone who has lost the zest for life with time, do get your Testosterone levels done and see a specialist today. Its could be a life changing decision.
Written by Dr. Raman Tanwar, MBBS, MS, MCh (Urologist and Andrologist)