You probably wouldn't have general acceptance among physicians that a lot of the package, for want of a better term, that is the male mid-life crisis is attributable in any meaningful sense to decreasing hormone levels. The andropause is marked by a decrease in the production of the male sex hormone testosterone.
Hormone Use in Menopause and Male Andropause - Sheldon J Segal - Bok () | Bokus
However, the depletion of testosterone is regarded as quite gradual after the age of 40, compared with the dramatic fall in the levels of the female hormone estrogen during the menopause. Three years ago, Prof John McKinlay from the New England Research Institute in Watertown, Massachusetts, described the male menopause as a myth and said that the symptoms were more likely due to unhealthy lifestyles. Basing his premise on data from the Massachusetts Male Ageing Study MMAS which looked at 1, men, he said male hormone levels declined only gradually with age, by about 1 per cent a year, and there was no evidence for the existence of a syndrome.
But Dr Malcolm Carruthers of Andropause Society in the UK argues that the condition exists and is often incorrectly confused with the psychological traumas of the male mid-life crisis. According to the Andropause Society, the male menopause is still neither recognised nor treated by the majority of general practitioners for a number of historical, image and medical reasons, such as difficulties in accurately measuring testosterone levels and concerns about early testosterone treatments.
Difficulty in defining the condition and a general lack of awareness about the condition has led to it being neglected, according to sex therapist Tony Duffy. The condition can be treated by carefully monitored testosterone replacement therapy, according to Carruthers, which he says is as safe and effective as hormone replacement therapy HRT for women.
Testosterone replacement therapy is available in a variety of forms, including injections, implants, tablets or skin patches, but the treatment has been linked to side effects such as prostate cancer in the past. There are concerns about the long-term use of estrogen hormones in women. Some cynics have said that the syndrome has been manufactured by drugs companies and some in the medical profession to create a lucrative market for treatments.
However, Boland urges caution over rushing to conclusions because many of the symptoms attributed to the andropause, such as erectile dysfunction, can often point to other problems.
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It can be due to relationship difficulties, alcohol, drug ingestion, stress, all those kinds of problems. There are normally a significant number of factors. Nor can the psychological factors of ageing be discounted for many of the symptoms that are now being attributed to the male menopause, he argues. In this study, a score of less than 10 was considered normal and was the target for treatment. The average age of the men was 54, with a range from 24 to The average length of follow-up to assess symptoms and testosterone levels was one to two years after treatment.
Treatment lasted from 3 to 12 years depending on the testosterone delivery implant, gel, pill or cream. Some treatments led to symptomatic relief within a year. Men with more severe symptoms were less likely to respond well to the testosterone therapy. None of the men were reported to have an increased prostate after testosterone treatment, but the average follow-up was just one year. These men had to be treated for this by having blood taken regularly to reduce the number back to safe levels.
The researchers concluded that, "With appropriate and necessary monitoring of safety parameters, testosterone treatment appears safe and economic. This study found that offering men testosterone when they reported symptoms usually described by men with low testosterone caused a reduction in their symptoms. The authors say that treating people according to symptoms should be more important than basing it on testosterone blood levels alone. They say these blood levels may be inaccurate, and some individuals may naturally need higher levels of testosterone than others.
This is an interesting concept worthy of further robust study.
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However, there are potentially serious side effects reported with testosterone therapy, and this study does not address these risks or provide evidence that more people should be treated. They only recommend that testosterone is prescribed for men who do not produce testosterone or who have low levels as a result of a medical condition that requires treatment, such as chemotherapy.
In the UK there are no official NHS guidelines, but the Society for Endocrinology recommends that male patients are treated on a case-by-case basis, depending on their symptoms. If you suffer from the symptoms described above, it may be worth seeing your GP — testosterone replacement therapy is effective for men who are found to have low testosterone levels. It remains to be seen whether the benefits of testosterone therapy would outweigh the risks for men currently considered to have testosterone levels within the normal range.
Many problems with issues such as erectile dysfunction and loss of libido are often the result of psychological, rather than physical, issues. It may be unwise to seek out hormonal treatments without first speaking to a sex therapist or a similar type of counsellor. Is the 'manopause' more widespread than we thought? Male menopause is real, claims controversial new study.
Could testosterone HRT help treat the male menopause: Therapy should be provided as men also suffer hot flushes and low libido once they pass Evolution of testosterone treatment over 25 years: symptom responses, endocrine profiles and cardiovascular changes. In men, production of testosterone and other hormones declines over a period of many years and the consequences aren't necessarily clear.
So what's the best way to refer to so-called male menopause? Many doctors use the term "andropause" to describe aging-related hormone changes in men.
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Other terms include testosterone deficiency syndrome, androgen deficiency of the aging male and late-onset male hypogonadism. Testosterone levels vary greatly among men. In general, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. A blood test is the only way to diagnose a low or reduced testosterone level.
Some men have a lower than normal testosterone level without signs or symptoms.
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In this case, no treatment is needed. Some of these signs and symptoms can be caused by underlying factors other than low testosterone, including medication side effects, thyroid problems, depression and excessive alcohol use. There also are conditions such as obstructive sleep apnea that might affect testosterone levels.
Once these conditions are identified and treated, testosterone typically will return to a normal level. If you are experiencing signs and symptoms that might be the result of a low testosterone level, consult your doctor. He or she can evaluate possible causes for the way you feel and explain treatment options. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, the benefits aren't clear and there are possible risks.
Among the risks, testosterone therapy contributes to sleep apnea, stimulates noncancerous growth of the prostate and stimulates growth of existing prostate cancer. Testosterone therapy may also increase the risk of heart attack and stroke and contributes to the formation of blood clots in the veins. If you wonder whether testosterone replacement might be right for you, work with your doctor to determine why your testosterone level is low and whether it is causing your symptoms.
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