May 17, 2001 (San Antonio Express-News) - Retired Houston truck
driver Clifton Cormier thought he was ``just getting old'' several
years ago when he started feeling more aches and pains than usual
and was constantly tired. More distressing, his memory wasn't as
sharp as it used to be.
``I'd do a crossword puzzle, and the next day I could almost do
it again - I'd forgotten all the answers,'' said Cormier, 76. ``And
my muscles were shrinking. The backs of my legs looked like
prunes.''
Fortunately for Cormier, his doctor recognized these as more
than symptoms of advancing years and referred him to Dr. Robert S.
Tan, a Houston geriatrician, a doctor who specializes in care of
the elderly. After getting the results of a blood test, Tan, the
author of ``The Andropause Mystery'' (AMRED Publishing, $19.95),
immediately prescribed testosterone replacement therapy.
Cormier's diagnosis may not have said so specifically, but what
he was experiencing was what is popularly known as male menopause.
Sometimes called ``puberty in reverse,'' this is the period in a
man's life when production of a number of vital hormones -
primarily testosterone - begins to decline. The facile comparison,
of course, is with female menopause. But there are important and
distinct differences between the two.
Indeed, not everyone buys into the concept that male menopause
even exists. The public perception is that male menopause is the
punch line of a hoary joke, complete with references to hot cars,
hot babes and, yes, hot flashes.
Physicians are not among the nonbelievers. Earlier this month,
at the San Antonio meeting of the American Association of Clinical
Endocrinologists, there were two major presentations on treating
androgen deficiency. (Androgens are a group of hormones of which
testosterone is the most powerful.)
One source of the confusion is the name used to describe the
syndrome. ``Calling it male menopause is biologically silly and
anatomically improbable,'' said Dr. Richard F. Spark, the Harvard
Medical School professor whose 1980 Journal of the American Medical
Association article was among the first to suggest that impotence
isn't always all in a man's head.
The word menopause means a pause, or cessation, of the menstrual
cycle. And since men don't have menstrual cycles, they can't stop
having them.
Not that the medical community hasn't tried to coin
alternatives. What the lay public calls male menopause has been
referred to, at times, as hypogonadism, viropause and ADAM
(androgen decline in aging males). The name that seems to have the
best odds of sticking is andropause, or the cessation of production
of androgens.
Produced in the testes, testosterone is the hormone responsible
for many of the attributes that define a male. In the womb, it
shapes the male genitals. During adolescence, well-timed surges of
the stuff help turn a boy into a sexually mature, deep-voiced,
hirsute man.
Sometime between age 45 and 60 (younger for some men, older for
others), testosterone production slows and less and less is pumped
into the bloodstream. However, unlike estrogen production in women,
which comes to an abrupt and complete halt with the onset of
menopause, testosterone levels in men taper off gradually during
many years.
This long, slow decline means that men - who are usually not as
in touch with their bodies as women - are often unaware of the
subtle changes they're undergoing.
``Usually a patient will come in for other issues, and when I
ask about, say, sexual functioning, they say, `Oh yeah, that's a
little off, too,''' said Dr. Jerome S. Fischer, an endocrinologist
at the Diabetes & Glandular Disease Clinic in San Antonio.
Symptoms of male menopause will sound eerily familiar to any
woman who already has undergone the change: irritability, mood
swings, depression, anxiety, palpitations, memory loss. About one
in 10 men even suffer hot flashes.
And since testosterone plays such a vital role in sexual
functioning, a drop in production usually triggers a concomitant
decline in libido and virility and an increase in erectile
dysfunction. This doesn't necessarily relegate a man to complete
impotence, only a loss of the anywhere/anytime erections of his
younger days.
But male menopause involves more than just physical changes.
``Sure it's a physiological event,'' said Jed Diamond, the
author of ``Surviving Male Menopause'' (Sourcebooks, $16.95). ``But
these changes also affect a man psychologically, socially and
interpersonally. Treating the syndrome means treating these
problems, too.''
Diagnosing male menopause is often a matter of taking a medical
history and doing a complete physical. Often, it's the simple
things that shed light on the problem.
For example, a man who suddenly has to shave only once or twice
a week instead of every day may well be suffering testosterone
deficiency. On the other hand, the presence of so-called
male-pattern baldness is usually a sign (albeit an unwelcome one)
that a man has sufficient amounts of the hormone.
Doctors who suspect a problem probably will order a series of
blood tests. Because testosterone production occurs in spikes
throughout the day, several are needed during two to three hours.
While relatively few patients are found to be clinically
deficient in testosterone, those who are can be treated with either
hormone injections or newer gels or patches applied to the skin.
For most men, the results are dramatic and almost immediate.
Cormier said he started seeing a difference after only his
second once-a-month shot. ``My memory's sharper, I'm more mobile,
my quality of life is much better,'' he said. ``I'd even thought
that nighttime erections were a thing of the past, but they're
back.''
While testosterone replacement is usually effective, physicians
caution it should be used only to treat clinical deficiencies. It
is not, said Fischer, a supplement or a vitamin and must be
administered under strict medical supervision.
Side effects include increases in both cholesterol and blood
pressure, growth of body hair, male-pattern baldness, acne and
fluid retention. All are treatable.
