Do men experience a "change of life" in
middle age -- a hormonal shift equivalent to menopause in women? Debate over the
concept of "male menopause" continues to illicit widely divergent viewpoints, as
evidenced by two opposing arguments made by British researchers published as a
"For and Against" editorial in the March 25th issue of the British Medical
Journal.
Presenting evidence for the existence of significant hormonal changes in
men, Duncan C. Gould and a colleague from Goldcross Medical Services in London,
UK, highlighted the fact that concentrations of testosterone decrease by up to
50% in men between the ages of 25 and 75.
In addition, the authors note that 50% of men over age 50 have abnormally
low levels of testosterone due to changes in their endocrine (hormone) systems.
The researchers point out that this steady decline often manifests itself in
symptoms that are similar to those observed in menopausal women: hot flashes,
sweats, depression, nervousness, fatigue, and an overall drop in energy.
The team also notes the association between aging and an increase in body
fat in men, which they suggest may be attributable to a drop in growth hormone
concentrations.
However, while Gould and his colleague argue "for" the medical acceptance of
a male equivalent of menopause, they suggest that the term "male menopause" may
be a misleading choice of words in that the overall male hormonal decline is
gradual and linear and occurs in only some men, while for women, the hormonal
drop experience is universal and sudden. The authors suggest the term
"andropause" may be a more accurate label to describe the male experience.
Professor Howard S. Jacobs, on the other hand, makes the case that
regardless of what it is called, there is no valid conceptual equivalent of
menopause among men. Jacobs -- of the Royal Free and University College School
of Medicine at Middlesex Hospital in London -- argues that the gradual nature of
the changes in testosterone levels among aging males is a fundamentally
different experience than the fast depletion of estrogen levels among menopausal
women.
Jacobs suggests that treating men with testosterone hormonal supplementation
in a manner similar to the estrogen supplementation commonly given to menopausal
women does not achieve comparable results -- citing studies that have shown that
among men there is no significant increase in bone mineral density levels or
muscle strength after such treatment.
Deducing that if similar treatment methods are not similarly effective then
the medical conditions are not similar to begin with, Jacobs concludes that the
hormonal and biological changes in aging men -- exemplified by testicular
failure and a decline in muscle and bone mass -- are simply functions of growing
old rather than "male menopause."
As further proof of a striking difference between the male and female
condition and treatment scenario, Jacobs also notes that the development of the
popular nonhormonal prescription drug Viagra has successfully addressed the
issue of erectile dysfunction that affects 50% of men between the ages of 50 and
70 -- and has done so in a much more effective manner than hormonal treatment
has traditionally been able to achieve.
In interviews with Reuters Health, both Gould and Jacobs expressed
confidence that their arguments are sound and sensible. Gould emphasized that
while "male menopause" is a "silly term" that can and does lead to confusion, it
nonetheless reflects a real set of hormonal changes that affect 1 out of every 2
males. "In men," he said, "there's a gradual decline from the age 35 to 40 in
testosterone levels, and in some men the drop is noticeable quickly because they
start with relatively low levels of testosterone, while some men... will start
with very high levels."
Gould added that by acknowledging this set of facts and giving the condition
a name, the medical community is simply allowing for proper diagnosis and
appropriate treatment. "If you diagnose someone with low testosterone levels,
you give them testosterone treatment according to the World Health Organization
guidelines," he stated.
On the other hand, Jacobs countered plainly that the notion is without
medical support. "I think the people that are talking about it are in a kind of
'time warp,'" he said. "The 'male menopause' notion was put together before the
invention of Viagra. They haven't quite realized that it's Viagra -- a
nonhormonal remedy -- which is what cures the impotence of the elderly rather
than hormone treatment. And Viagra's a pretty safe drug."
Jacobs summed up his take on the debate by stating that "the proposed notion
of 'male menopause' just has no support in endocrinology.... And the people that
are talking about it certainly haven't bothered to follow-up the modern medical
literature."
