Male menopause: Fact or fallacy?

By Funmi Akingbade (cafi.punch@yahoo.com)

Alaji Samna, 48, is one of the several men that come to my office and complain of serious health challenges that no one seems to be able to diagnose. Alaji Samna, like the rest, says he is totally uninterested in sex. He also says he experiences a lack of libido, even when sexually aroused. Alaji Samna said, "Even when I try to satisfy my two wives out of obligation and not out of interest, I always have a very low energy level." He has been to several doctors but no one could tell him what was wrong. Eventually, he was diagnosed with androgen deficiency, a problem of low testosterone level in the body, also known as male menopause. He wanted to know if testosterone replacement therapy is advisable. Should he go for the injection or rub the testosterone on his shoulders for a better sex life? he wanted to know. I'm less than a man without sex, he said.

Men experience a decline in the reproduction of the male hormone testosterone with aging, but this also occurs with some diseased states such as diabetes. Along with a decline in testosterone, some men experience symptoms such as fatigue, weakness, depression and sexual/erection problems. Unlike menopause in women, which represents a well-defined period in which hormone production stops completely, testosterone decline in men is a slower process. The testes, unlike the ovaries, do not run out of the substance needed to make testosterone. A healthy male may be able to make sperm well into his eighties or longer. While it is also relatively easy to diagnose menopause in women when their menstrual period stops, diagnosing male menopause is trickier and requires a blood test. Consequently, the condition often goes undetected.

Definitely, loss of testosterone in a man can lead to testosterone deficiency, which has a bad impact on his ego and takes a toll on his health. Among other potential causes of testosterone deficiency are: injury or infection to the testicles, chemotherapy or radiation treatment, genetic abnormalities such as extra 'X' chromosome, too much iron in the body, dysfunction of the pituitary gland, medications, stress and alcoholism. Of the estimated four or five million men with low testosterone, only five per cent currently is being treated. About one in every 10 men between the ages of 40 and 60 has low testosterone. Among men over the age of 60 the numbers jump to one in every five men, according to researchers. The big question now is this: Is testosterone replacement therapy healthy, even if it needful?"

Some studies have shown that TRT in men who have low levels of the hormone may improve libido, enhance sexual performance/ function, increase bone mineral density, increase muscular mass/strength and help improve mood. However, the adverse effects of TRT outnumber its advantages. One of the disadvantages is sleep apnea, a potentially serious disorder in which breathing repeatedly stops and starts. TRT causes the body to make too many red blood cells, which can increase the risk of heart disease. It also causes acne or other skin reactions, stimulates noncancerous growth of the prostate and possibly encourages the growth of existing prostate cancer.

It also enlarges the breasts, limits sperm production and causes the testicles to shrink. So, if you are considering testosterone therapy to help you feel younger and more vigorous as you age, know the risks before you make your decision.

There are the second categories of men who have low level of testosterone not because of aging but because of a disease called hypogonadism. This is a condition in which the body is unable to produce normal amounts of testosterone due to a problem with the testicles or with the pituitary gland that controls the testicles. Testosterone is a hormone produced primarily in the testicles. Testosterone helps maintain men's bone density, fat distribution, muscle strength and mass red blood cell production as well as sex drive and sperm production. Testosterone peaks during adolescence and early adulthood. As a man gets older, his testosterone level gradually declines to typically about one per cent a year after age 30. It is important to determine in older men if a low testosterone level is simply due to the decline of normal aging or if it is due to a disease hypogonadism. TRT can improve the signs and symptoms of low testosterone in men with hypogonadism, with fewer side effects than in elderly men. TRT can help reverse the effects of hypogonadism, but it's unclear whether testosterone therapy would have any benefit for older men who are otherwise healthy.

Many also want to know if testosterone therapy helps increase sex drive in women. Well, research shows that testosterone hormone does impact sex drive as well as remedies other sexual problems in certain women with sexual dysfunction. But the long-term safety of testosterone therapy for women is unknown. Testosterone therapy usually is prescribed only for women who have low libido but sufficient estrogen levels.