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Debating the Existence of Male Menopause

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WebMD Health News

March 24, 2000 (Atlanta) -- Sexual dysfunction, loss of libido, depression and nervousness, poor concentration and memory, hot flashes and night sweats, loss of bone density, and muscle weakness. This list of symptoms is usually discussed in relation to female menopause, but some physicians believe the symptoms are also applicable to men when, around midlife, their testosterone levels drop below a certain level -- a sort of "male menopause," if you will. In this week's British Medical Journal, three physicians address the question of whether male menopause -- sometimes called andropause or climacteric -- really exists.

Arguing on the "pro" side, Duncan Gould and Richard Petty, of the Goldcross Medical Services in London, write it has been recognized in the medical literature that many middle-aged men experience a variety of symptoms similar to what menopausal women experience. While Gould and Petty believe the term "menopause" is inappropriate because it suggests the same sudden drop in hormone levels that women undergo, they cite articles and studies pointing to low testosterone as the root of these changes and testosterone replacement as a potential treatment.

"The main point that [Gould] raised is that firstly, the [symptoms] of the male menopause, which is identical to that of the female, as far as it can be, has actually been recognized for 60 years, and that these symptoms go away when you treat with testosterone," Malcolm Carruthers, MD, speaking on behalf of his colleague, tells WebMD. "He also goes into the hormonal background ... emphasizing a very important point ... [that] testosterone decreases by 50% between the ages of 25 and 60 to 70. And although it isn't such a precipitous drop in hormone level as women get at menopause, we believe it is quite sufficient to precipitate these characteristic features."

Carruthers says just because a decline in testosterone is a natural part of aging doesn't mean men should suffer with symptoms. "What we call ADAM -- androgen deficiency in the aging male -- does occur, but it is not, as it has been taken to be before, a recipe for inactivity," he says. "People say, 'Well, if it happens with age, it's natural, so don't do anything about it.' I think that argument was used with female hormone replacement therapy. You can reverse some of these effects which have been attributed to age alone -- like muscle weakness, osteoporosis, and increasing body fat -- by testosterone treatment. So it is not inevitable. I think that is the important message."

Not so fast, argues Howard Jacobs, who writes that many of the changes that occur in men are not the result of a decline in hormones, rather they "should be attributed to the passage of years." He agrees that testosterone levels drop, but he says that drop actually causing symptoms such as a reduction in sexual activity and a decline in muscle bulk and bone strength has yet to be proven. Furthermore, he writes, testosterone therapy has had less than impressive results among healthy, older men in several studies. Jacobs is emeritus professor of reproductive endocrinology at Royal Free and University College School of Medicine, Middlesex Hospital, in London.

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