Research looks at ‘male menopause’

Zoomer | August 1st, 2000

For years, women have had to choose whether to treat menopause as a natural phenomenon, like the changing seasons, or as an aging process requiring hormone therapy. For 50 years, they’ve debated whether the benefit of treatment with hormones was greater than the risks.

Now women have company. I recently attended the second world congress on “The Aging Male” in Geneva, Switzerland, and learned that after years of denying the probability of a male menopause (andropause), males now have to admit they’ve been wrong.

Dr. John Morley, director of geriatric medicine at St. Louis University, says “For years I’ve been telling doctors that testosterone levels decrease 10 per cent every 10 years. And that by age 40, about 40 per cent of men suffer from relative impotence. But until recently, physicians refused to acknowledge it.”

Andropause questionnaire

So how do you tell if you’re suffering from the andropause? Morley has devised the following test:

Do you have decreased interest in sex?
Do you have a lack of energy?
Do you have a decrease in strength and/or endurance?
Have you lost height?
Have you niced a decreased enjoyment in life?
Are you sad and/or grumpy?
Are your erections less strong?
Has there been a decreased ability to play a sport?
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?

What are options?

Men who answer “yes” to questions one or seven, or to any three questions, may be suffering from the andropause and low testosterone levels. Morley suggests that men who fail this test in all probability require testosterone.

He uses the test strictly as a screening procedure — appropriate candidates are checked for bioavailable testosterone in their blood and, if it’s low, testosterone replacement therapy (TRT) is suggested.

Does the treatment have a downside? Since its discovery, doctors have worried that the use of testosterone might trigger enlargement of the prostate gland, or even worse, cause prostatic cancer. In fact, experts agree that testosterone could cause an undersized prostate gland to enlarge, but only to its normal size. They found no supportive evidence that testosterone causes prostatic malignancy.

Is therapy safe?

Dr. Malcolm Carruthers of London, England, has claimed for years that it’s safe to use testosterone therapy. He admits testosterone can increase the growth of an existing cancer, but does not initiate one. In fact, giving testosterone may even result in earlier diagnosis of cancer as patients receiving the treatment are examined more frequently.

Prior to starting testosterone therapy, men must have a general examination, including a rectal examination, and PSA test to rule out prostatic cancer.

Dr. Alvaro Morales, professor of urology at Queen’s University, Kingston, Ontario, says it’s prudent to prescribe Andriol, an oral form of testosterone available in Canada, for a trial period of three months. If Andriol has no clinical effect, it should be stopped. Should there be improvement, it can be continued.

The big question is, how many men will opt for treatment? Judging by the example set by women, there won’t be a stampede to the doctor’s door (only 15 per cent of menopausal women use hormone replacement therapy).

Men have not insignificant obstacles to overcome. First, if they fail the Morley test, many will simply refuse to accept the results or will be too embarrassed to seek medical attention. Even if they do opt for treatment, finding a physician willing to prescribe Andriol is another matter entirely — most physicians know little about andropause.

Testosterone for heart, bones
But men and their doctors have to acknowledge it isn’t only the libido that can be affected by the andropause. Researchers claim that low levels of testosterone also trigger cardiovascular disease and osteoporosis (brittle bones).

Morales says: “There’s no question that men lose bone as they age. Moreover, giving testosterone can increase bone density in the lumbar spine and hips, but to a greater degree in the spine. There’s also evidence that a low blood testosterone level is a risk factor for cardiovascular disease, and that the use of testosterone can help prevent heart disease.”

But how does testosterone decrease the risk of myocardial infarction? Several years ago, Dr. Philip Sarrel, professor of gynecology at Yale University, discovered that estrogen dilates coronary vessels while progesterone constricts them. And he shocked doctors by presenting cases in which he believed the use of progesterone had caused either a heart attack or stroke.

Dr. D. Crook, a London, England, cardiologist, stunned the world congress with similar evidence. His studies show that testosterone also dilates coronary arteries.

This has interesting implications. For instance, when heart attack patients are admitted to an emergency room they’re routinely given medication to dilate blocked coronary arteries. This evidence suggests that, in future, patients may also receive an intravenous injection of testosterone for the same reason.

Researchers at the congress also announced good news about the effect of testosterone on lipid metabolism. Dr. Roland Tremblay, an internationally respected Quebec endocrinologist, reported that testosterone has a positive effect on blood lipids. Studies show it lowers blood cholesterol and decreases low-density lipoproteins (the bad cholesterol), increases high-density lipoproteins (the good cholesterol), and decreases triglycerides.

Missed diagnosis
Another interesting message came out of Geneva – that diagnosis of male menopause is often missed. In fact, some physicians were prescribing antidepressant medication such as Prozac, when what was actually needed was long-term testosterone therapy.

Future research will demonstrate how the use of testosterone will prevent heart attacks, fractured hips and collapsed vertebra.

In the meantime, selling the benefits of testosterone replacement therapy to men isn’t easy. Unlike women, men are more apt to see a doctor to be repaired, rather than to seek prevention.

Consequently, too many men suffer prematurely from diseases that are largely preventable.

The best approach for these men? Visit the doctor. There’s every chance that Andriol could revitalize the machismo and put a little of that old tiger back in the tank.