The male menopause explained

What Is The Male Menopause?

Age related testosterone deficiency and the ‘male menopause’ are conditions that are now receiving significant attention from the media and doctors alike.

The term ‘Male Menopause’ refers to the symptoms associated with the gradual reduction in testosterone levels experienced by the ageing man that leads to a testosterone deficiency and the symptoms associated with this.

Unlike the female menopause – where there is a rapid decline in hormone levels at around 50 years of age, in the ‘male menopause’ also known as the ‘Andropause’, ‘Androgen Deficiency in the Ageing Male (ADAM) ‘ and ‘Late onset male hypogonadism’, testosterone is lost at a much slower rate.

Typically, starting from around the thirties onwards, the gradual age-related decline in testosterone levels is around 2% per year.

Symptoms associated with male testosterone deficiency include:

• Mood disturbance
• Erectile dysfunction
• Loss of libido
• Weight gain
• Low energy levels
• Lack of motivation
• Loss of lean muscle mass
• Hair loss
• Decrease in testicle size
• Hot flushes
• Poor sleep
• Poor memory
• Decreased body hair

All those symptoms can significantly affect a man’s quality of life. In addition, men who are testosterone-deficient are more likely to develop diabetes, heart disease, obesity, osteoporosis and Alzheimer’s disease.

It is, therefore, important that, if you do suffer from any symptoms that may be associated with the ‘male menopause’ that a full check up is conducted by a doctor with an interest in Men’s Health.

Diagnosis And Treatment Of Male Menopause

It is important, in the first instance, that you seek advice from a doctor with an interest in Men’s Health, and that you are honest and open with them. The doctor will conduct a full health check and seek to rule out any other medical conditions that may be causing your symptoms rather than testosterone deficiency.

Other conditions that may mimic symptoms of testosterone deficiency include:

• Side effects of medication
• Excessive use of alcohol
• Sleep apnoea
• Depression
• Diabetes
• Thyroid disorders

Dealing with these conditions may, in many cases, be enough to resolve the presenting symptoms.

Making healthy lifestyle choices will also help. These might include activities to relieve stress, healthy eating, sleeping well, regular exercise, smoking cessation and moderating alcohol intake.

Where symptoms are marked, and blood tests show reduced levels of the active hormone, testosterone replacement therapy or TRT may be an appropriate treatment option. The use of testosterone replacement therapy in men who do not have a demonstrable testosterone deficiency is not recommended.

Here at the ROC Clinic, we offer testosterone screening as part of our comprehensive Well-Man checks. At your first consultation, a doctor will take a full history and examination including prostate examination and arrange the appropriate blood tests including full blood count, liver and kidney function, blood sugar, serum uric acid, serum proteins, bone metabolism, full lipid profile, prostate specific antigen as well as a full hormone profile. Due to normal fluctuations in hormone levels, it is important that the blood tests are taken between 9am and 11am and before eating breakfast for an accurate result.

You will then be followed up at a second appointment with the results of your tests. If your testosterone levels are low, further specialised tests will be conducted and the doctor will discuss the treatment options available to you. If you do require testosterone replacement therapy, you will only need to attend the clinic every few months to monitor your hormone levels and make sure that the treatment regime is right for you.

Testosterone Replacement Products

Testosterone replacement therapy can be delivered in a number of forms – each with their own advantages and disadvantages. The most popular testosterone replacement products that are available in the UK are:

• Gels (Testogel/Tostram/Testim): Gel containing testosterone is applied from a tube, sachet or pump to the skin of the upper arms, shoulder or abdomen daily and is absorbed within minutes. Care must be taken not to transfer the product from the skin to other people;
• Injections: Unlike older formulations that required injections every one to three weeks, a newer formulation called Nebido requires injections at the clinic once every three months;
• Tablets (Restandol): Considered a convenient method by some men who want to avoid injections and gels, this method does have the drawback of variable absorption from day to day.

Are there any risks associated with Testosterone Replacement Therapy?

It is of paramount importance that any men suffering with symptoms of testosterone deficiency are fully assessed by a doctor before considering embarking on a course of testosterone replacement.

Testosterone replacement therapy is not suitable for everyone.

In March 2015, the FDA in America advised that it should only be prescribed for men who have a medical condition of the testicles, pituitary gland or brain causing their testosterone deficiency rather than simply those with normal age-related testosterone deficiency. Whilst larger scale studies of its use in simple age-related testosterone deficiency are expected, it is important that it is only used for those patients in whom a testosterone deficiency has been demonstrated rather than to simply combat the effects of ageing. In addition, any patient embarking on a course of testosterone replacement therapy must understand the potential risks.

If prescribed inappropriately, testosterone replacement therapy may be associated with an increased risk of heart attacks and strokes. Whilst there is no evidence that testosterone replacement therapy increases the risk of prostate cancer, it is important that men on testosterone replacement are regularly monitored for the development of benign prostate enlargement. For these reasons, all men who require testosterone replacement must undergo a full cardiovascular and prostate risk assessment at our clinic.

In addition, men with breast cancer, sleep apnoea and pre-existing heart problems should not be treated with testosterone replacement.

Testosterone therapy acts as a contraceptive and can suppress fertility long term. Therefore, men wishing to have children in the future should avoid it.
Other possible side effects of treatment include acne or oily skin, enlarged breast tissue, liver and testicular shrinkage.

For further information regarding our Well Man Consultations please contact Dr Sam Al Jafari at ROC Clinic. (Contact page)