Oh, man, menopause? !!!!!!!!

[Daanyeer]

Experts debate male midlife crisis

Source: via mensdaily
Kate Santich
Sentinel Staff Writer
Posted October 3 2006



For years the concept of a male equivalent to menopause was little more than a punch line to snide remarks about middle-age men. But in recent years the issue has attracted increasing scientific scrutiny -- while sales of supplemental testosterone have boomed.

Unfortunately, most experts say, the marketplace is ahead of the medical research.

"Certainly we know that male hormone levels drop slowly throughout a man's life," says Dr. Richard Hellman, president-elect of the American Association of Clinical Endocrinologists -- doctors who specialize in the body's hormone system. "The question is: Is it troublesome to men? And the answer is, not necessarily."

In fact, many physicians don't even recognize the term andropause -- or male menopause -- calling it a misnomer because there is not the same sort of "pause" that women experience when they stop menstruating. The National Institute on Aging, for instance, labels andropause "a speculative term that is not accepted or used by the scientific community" and has published warnings against testosterone supplementation, saying that only men with an "extreme deficiency" should consider its use.

But a growing minority of doctors argues that such an attitude does men a disservice and can leave them with a litany of joy-robbing symptoms -- increased irritability, depression, fatigue, inability to concentrate, reduced muscle mass and strength, low sex drive, erectile dysfunction, decreased bone density and increased body fat. Low levels of testosterone, the principal male sex hormone, might even increase the risk of heart disease and diabetes.

"All I can say is that, in my area, in Jacksonville -- a city of 1.5 million people -- I don't know of any urologist or any endocrinologist that specializes in this or cares anything about it," says Dr. C.W. Randolph, a gynecologist who began treating men about five years ago and now sees two or three male patients a day. His book, From Hormone Hell to Hormone Well, though mainly aimed at women, also addresses the health issues of middle-age and elderly men.

Yet part of the difficulty in making generalizations about male hormones is that they are highly variable from one man to the next, so there is a wide range of what is considered normal. Randolph, who contends that most older men could benefit from testosterone supplementation, says he has seen men in their 40s with dramatically low levels of testosterone, while other men a decade or more older turn out to have plenty.

Different pressures

No one disputes that testosterone can have powerful effects, which is why it has long been abused by athletes for increasing muscle strength, bone density and aggression. The hormone also enhances libido, energy and immune function, and it offers protection against osteoporosis, a sometimes-debilitating loss in bone density.

But testosterone supplementation might be dangerous too, and the long-term effects are still unknown. One of the most common responses in men given the hormone, Hellman says, is an increase in their red-cell mass, which can lead to a greater risk of blood clots and stroke.

Further, testosterone therapy can heighten the risk of prostate cancer, the second-leading cause of cancer death in men, either by spurring the growth of new tumors or by accelerating the growth of existing ones.

So why did worldwide sales of testosterone-replacement therapies for men soar to $628 million last year? Why has the market boomed for shots, patches, gels and natural hormones from Mexican wild yam and soy?

Some experts credit -- or blame -- aging baby boomers looking for a fountain of youth. Others say a growing "anti-aging" specialty among doctors has led men to think that the normal process of getting older is actually a disease that should be treated.

But still others think that, in an era when former vice presidential candidate Bob Dole became a pitchman for Viagra, men are reluctantly beginning to talk about diminishing virility with their doctors.

The Alliance for Aging Research, for one, applauds such progress. Earlier this year, that nonprofit agency launched a campaign to encourage men with two or more symptoms of low testosterone to ask their doctors about getting a simple blood test to check their hormone levels.

"Certainly we're not saying all men should be on testosterone replacement," says the alliance's executive director, Daniel Perry. "We're not even saying all men with low levels should be on testosterone replacement. But we are saying that if you have two or more of these symptoms, you really should ask your physician -- because chances are your physician is not going to ask you. We're finding with older men and women that physicians are saying, 'So you're cranky and unhappy. You're 75, what do you expect?' It's ageism, pure and simple."

No easy answers

The group estimates that as many as 5 million American men might suffer from clinically low levels of testosterone. And according to a Finnish study published last year in the Journal of the American College of Cardiology, such men can face increased risk of cardiovascular disease because of thickened arteries. However, the researchers cautioned that further study is needed and that testosterone supplements might -- or might not -- decrease the risk.

And that's yet another problem with testosterone. Though men with extremely low levels often feel markedly better on the supplement, those with levels in the lower range of what's considered normal might not derive much benefit from it.

"The older we get, the less responsive we are to many hormones," Hellman says. "What might have an enormous effect in a young person is modified as we age."

But the bottom line is that there is still much scientists don't know on the subject, and doctors on both sides of the debate say more studies are needed.

Meanwhile, Hellman says, no one debates that the biggest differences in longevity and quality of life generally are made by such lifestyle changes as maintaining a healthy weight, exercising, eating nutritiously and not smoking.

"The harder things to do," he says, "turn out to be the most enduring."