Oct. 4, 2001 -- Have you ever heard, "Don't mind Steven, he's just going through the change of life?" That's right -- "he," not "she." According to some researchers, the idea may not be so far-fetched.
'Male Menopause' Research
The concept of a "male menopause" and the need for hormone replacement therapy as a treatment is still highly controversial, but you wouldn't know that from one doctor's attempt to recruit men for his study. Jerald Bain, MD, set out to find 100 subjects to participate in his study -- 900 volunteered for the chance to get a male hormone pill for what ailed them.
In the end, Bain, who is an endocrinologist at Toronto's Mount Sinai Hospital and the director of the Health Institute for Men at the King's Health Center in Toronto, was only able to use 30 subjects. His data has now been collected and he is analyzing it. He contends that "there is no basis for the assumption that the male hormone, testosterone, is dangerous."
Andrew Dott, MD, and Anthony Karpas, MD, of the Institute of Endocrinology and Reproductive Medicine in Atlanta, contend that about 40% of 40-something men experience these symptoms to some degree:
- lethargy, or fatigue
- increased irritability
- mood swings
- loss of bone density
- decrease in lean muscle
- increase in fat
- anemia, or low blood levels of iron
- decreased libido
- difficulty in attaining and sustaining erections
- excessive alcohol consumption
- high blood pressure, or hypertension
- prescription drug use
- nonprescription drug use
- poor diet
- lack of exercise
- poor circulation
- psychological problems
Not 'Just Aging' Anymore
According to Bain, until recently, most doctors have considered these symptoms just part of aging and have ignored them. But now, he says, "we're beginning to realize we don't have to accept them all. We can accept the loss of strength, but to have to lie in bed at age 60 because of weakness and fatigue is not something we should accept."
Although men can experience a decline in testosterone levels with increasing age, and despite 150 years of attempts to rejuvenate men with hormone replacements, "male menopause" is still widely ignored. Malcolm Carruthers, a British specialist in men's health with a practice in London, suspects that one reason is historical.
A Questionable Past
The first successful use of hormone replacement was carried out 150 years ago by a German professor named Berthold who transplanted a rooster's testes into another castrated rooster. This procedure prevented the castrated rooster's comb from withering away. That study was followed by numerous other experiments using testicular transplants and extracts.
Testosterone was only isolated and synthesized 60 years ago. However, the oral form can be toxic to the liver and heart, and that, Carruthers says, has "colored the thinking of two generations of physicians."
Another problem associated with the diagnosis of "male menopause" is that only about 13% of men with symptoms have a low total testosterone level. Carruthers and others, however, say doctors need to evaluate the level of free active testosterone, or FAT, rather than total testosterone levels. FAT is obtained by dividing the total plasma testosterone level by that of the sex hormone binding globulin, or SHBG. This turns out to be low in 74% of the men with menopausal symptoms. SHBG increases with age and "zaps" the free testosterone before it can get into the cells to do its job.
Still, Skeptics Abound
Skeptics of andropause still abound. In an article in American Journal of Psychiatry, UCLA psychiatrist H. Sternbach concluded that "testosterone decline/deficiency is not a state strictly analogous to female menopause and may exhibit considerable overlap with primary and other secondary psychiatric disorders."
British urologists N. Burns-Cox and C. Gingell concluded in another medical journal that "the symptoms of the andropause fatigue can readily be explained by stress, and there is no scientifically valid ... study that shows any benefit for testosterone supplements in this uncommon group of patients."
Carruthers, however, has been following men who have taken testosterone supplements for up to five years, and he has concluded that the supplements cause no negative effects on their hearts, livers, or prostates.
And Dott and Karpas point out that when it comes to diagnosis, doctors should not just evaluate testosterone levels. "Good medical care dictates that a comprehensive medical and psychological assessment along with a thorough laboratory assessment are necessary," they say.
Possibly this debate will be solved once Bain completes his analysis of data comparing men with "menopausal" symptoms on hormone replacement with men receiving placebos. If so, will men rush out to get hormone replacement therapy? Stay tuned!