Debating the Existence of Male Menopause
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
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.