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Male Menopause:
Fact or Fiction?

Hot flashes, mood swings, night sweats are common symptoms experienced by women entering menopause due to the loss of functioning ovarian follicles that produce estrogen and progesterone.

As men age, they experience a decline in the male hormone testosterone, especially free testosterone. This decline is sometimes called Andropause or ADAM (Androgen deficiency in the aging male). It has also been referred to as “late onset hypogonadism”—the loss of male hormone production that occurs in younger men. The male transition happens more gradually than female menopause and is not defined by a single, tangible occurrence such as the cessation of the menstrual cycle.

So does male menopause really occur and what’s the controversy? Testosterone is responsible for many male characteristics including maintenance of body, pubic and facial hair, libido, and muscle and bone mass.

As men age, the loss of function experienced is similar to symptoms of hypogonadism, raising the possibility that lower testosterone is directly responsible. These changes include: increased body fat, decreased muscle mass, decline in sexual function, decline in bone density, decline in cognitive and memory function and fatigue.

What isn’t scientifically known is whether testosterone treatment corrects these age related declines. Many say they do help, but before you opt for supplementation, understand that it isn’t known whether certain diseases of older men worsen because of treatment. Possible risks include: prostate enlargement or prostate cancer growth, elevations in red blood cell counts, worsening sleep apnea and sometimes fluid retention.

If you have symptoms suggesting low testosterone levels, your health care provider. Blood tests are available and if they unequivocally show a low testosterone level, evaluation for primary or secondary hypogonadism (decreased testicular or pituitary function) should be undertaken. Testosterone replacement can then be considered after appropriate evaluation.

Dwindling Testosterone

Aside from aging, there are many other reasons for a drop in testosterone levels. Causes include:

• Testicle damage, especially the Leydig cells, during sports or other physical trauma.
• Mumps after puberty can cause an inflammation of the testes that interferes with testosterone and sperm production.
• Radiation treatment or chemotherapy can have a negative effect on the Leydig cells.
• Testicular or pituitary tumors can have an impact on the testosterone level.
• HIV/AIDs and other serious viral infections can inflict damage on the pituitary gland, the hypothalamus or the testes.
• Genetic conditions such as Klinefelter’s, Kallmann’s and Prader-Willi syndromes and myotonic dystrophy all can have a negative impact on testosterone production.
• Vasectomy may damage the Leydig cells and lead to early andropause.

A recipient of the South Nassau Hospital Physician of Excellence Award, Steven J. Lomasky, M.D., is board-certified in endocrinology and metabolism. He practices in Rockville Centre.

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