• Dr Peter Chew

Menopause in men

Men may experience menopause, just like women. The condition is variably termed andropause, testosterone deficiency, androgen deficiency, or late-onset hypogonadism. It is related to the gradual decline of the male hormone, testosterone, with age.

Testosterone is a sex hormone produced by the testes. It plays many important roles in men, including regulation of sex drive (libido), bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm. Its levels peak at about 20 and start to decline gradually. It is estimated that the levels decline by about one percent every year after the age of 40.

Unlike female menopause, the development of symptoms in andropause is more gradual as testosterone levels decline slowly over a long period of time. The symptoms are only present in about 30% of men in their 50s. They include the following:

· Low energy, lethargy, constant fatigue,

· Depression or sadness,

· Decreased motivation, lowered self-esteem,

· Difficulty in concentrating,

· Insomnia,

· Increased body fat in the tummy area,

· Irritability and mood swings,

· Osteoporosis (brittle bones),

· Loss of sex drive,

· Erectile dysfunction,

· Reduced muscle mass and feelings of physical weakness,

· Gynecomastia, or enlargement of breasts,

· Loss of body hair,

· Hot flushes,

· Decreased bone density,

· Infertility.

It is important to note that many of the symptoms associated with andropause are also a normal part of aging. Andropause is usually diagnosed by correlating the symptoms with a low testosterone level in the blood. Many men do not seek treatment as they think they can manage the symptoms themselves without treatment. Oftentimes, many patients also feel too intimidated or shy to discuss sexual topics with their doctors.

Treatment usually involves making healthier lifestyle choices which include:

· Eating healthily,

· Exercising regularly,

· Getting enough sleep,

· Reducing stress.

Medication or a psycho-therapy, such as cognitive behavioural therapy (CBT) may help if symptoms of stress and anxiety get more severe. Sexual counselling and medications may help in erectile dysfunction. Hormone replacement using testosterone is another treatment option. This treatment may provide relief from the symptoms and help improve the quality of life in many cases. Testosterone is given in the form of tablets, patches, gels, implants or injections. But there are concerns regarding the side effects of testosterone such as the risks of developing prostate cancer.

Testosterone should not be taken by any man with prostate or breast cancer. If the patient has heart disease, is taking some medications such as blood thinners, has an enlarged prostate, or has kidney or liver disease, he should discuss with the doctor the pros and cons of testosterone therapy before deciding on the treatment.

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