Men have menopause, too! It’s called Andropause.
An instant moment of recognition happens when you mention the word menopause to women – or men. It’s synonymous with hot flashes, moodiness and depression and ‘unpleasant’ changes in the female body’s shape. But did you know that men go through a menopause of their own and it’s called andropause.
We know that menopause happens when women stop producing the necessary sex hormones –namely, estrogen and progesterone. When this happens around the ages between 45 to 55, it’s not fun. Thankfully, these symptoms can be treated with replacement hormones, preferably bioidentical hormones.
Back to men — or andropause. When does it happen? Usually, it’s about 10 years after menopause strikes in women. The symptoms are: loss of libido, poor sexual performance, less muscle mass, more weight in the mid-section, and mood changes. The most common misconception is that it should be treated with testosterone. Far too often I see testosterone prescribed for men in the cream form or weekly shots as a cure-all for andropause. The problem is, like most things, it’s not that simple.
To be sure, testosterone builds muscle, enhances sex performance, etc., but it often doesn’t function as testosterone in the body. Some of it is aromatized into estrogen and some of it converted into DHT (hihydrotestosterone). In fact, men at age 50 often have more estrogen than women of the same age. Let me clarify, just like women men have a combination of testosterone and estrogen, but the ratios are different.
Understanding and Treating Andropause
Blood tests are necessary when treating men with testosterone to quantify how much of the hormone is aromatized into estrogen. If estrogen is elevated, and it usually is, a medication should be given to prevent this conversion into estrogen. One such medication is Arimidex (anastrozole), which is taken once or twice a week. If this medication isn’t taken, the man may develop breasts like a woman, which is called gynecomastia. Additionally, it is the belief by some doctors that prostate cancer may be related to elevated estrogen.
If too much testosterone is converted to DHT, this could cause BPH, benign prostate hypertrophy, or permanent hair loss. Another common symptom is acne. The treatment to reduce this conversion is either Proscar (finasteride) or Avodart (dutasteride). But blood tests must be performed to know the whole story of how the additional testosterone is being utilized.
Testosterone can be given in many ways from creams to injections to surgically inserted pellets. The pellet is a good method of delivery, but it does leave a small scar. The creams are converted into DHT more rapidly by the various appendages of the skin, causing the mentioned hair loss and BPH. If one prefers using the creams, Avodart or Proscar should be taken also.
If injections are preferred, a patient can self-injected once a week, but as with other treatments, blood tests should only be performed until the levels are stabilized and there is better understanding of the body’s response. In addition, blood levels of testosterone should be kept at reasonable levels, as seen in a person of about 35 years old.
Of course, a thorough physical exam should be performed (especially a prostate exam) on anyone before being treated with testosterone.
Men who have had andropause properly treated may find the regimen bothersome at first, but virtually all of them think the benefits are well worth the trouble and expense. In fact, most men rave about it.
E. Ronald Finger, MD, FACS
Finger and Associates Plastic Surgery Center