Mid-life crisis, menopause or myth? The jury seems to be out on the existence of the male menopause. Ciarán Brennan reports
Officially, men cannot experience the menopause as, by its strictest definition, it marks the final cessation of menstruation. But it has been argued that men experience a phenomenon similar to women called the andropause, which can be accompanied by symptoms similar to those experienced by women such as lower sex drive, mood swings, irritability, tiredness and hot flushes.
The problem is that, unlike women, there is no clear sign to indicate the onset of the menopause, making it more difficult to diagnose, and the medical profession appears to be still divided on its actual existence.
"It's a phenomenon that probably would not be diagnosed often by the majority of doctors in the same way that the female menopause would," says Dr Ronan Boland, vice-chairman of the GP committee of the IMO and editor of mygp.ie.
"There isn't a neat package of symptoms where you can say they are attributable to menopause in men in the same way as they are in women. 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. 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 1,700 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.
"The mid-life crisis is a serious existential crisis, a psychological crisis, whereas the andropause or androgen deficiency is really quite a serious hormonal disorder that can wreck a man's working and married life because of the symptoms and the malfunctions both at home and work and the depression that can go with it," he says.
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.
"Because there isn't an awareness of the andropause, men don't tend to seek help when they start to lose their vigour and their interest," says Duffy.
"Whereas women say 'well maybe this is the menopause, I should go and get myself sorted out', there is very little awareness in terms of men, they probably tend to suffer in silence and put it down to the ageing process."
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.
"These treatments are not without very significant side effect risks in terms of high blood pressure risk, cardiovascular disease, depression, acne," explains Boland.
"There are a whole range of problems that can be associated with them and certainly there is no conventional wisdom yet that there is a role for the widespread use of replacement androgenic hormones in men," he says.
"In fact, there has been a significant pull back with hormone replacement therapy in women over the past couple of years. 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.
"It's a very real and serious condition," counters Carruthers.
"Why should the pharmaceutical industry be accused of creating these disorders instead of being thanked for providing increasingly easy-to-apply effective treatments.
"I, personally, and my patients are very grateful to the pharmaceutical industry for treating very real disorders and making the treatment possible."
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.
"Erectile dysfunction is probably the most common manifestation that one would see of decreased hormone levels but on the other hand impotence is very much a multi-factorial thing," he says.
"Because somebody has an impotence problem doesn't mean there is any hormone imbalance. 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.
"I think it would be fair to say that the majority of the symptoms, stresses and the difficulties that would be put down to the mid-life crisis are due to non-physical factors. They are partly due to decreased androgen levels but they are a lot more likely to be due to the demands that modern society is placing on the individual.
"It is probably the decade between 40 and 50 where there are most demands placed on the average males in the marriage or domestic situation and job situation."
What are the signs?
Decrease in sex drive, lack of libido, erectile dysfunction and impotence.
Tiredness, fatigue and lack of energy.
Weight gain, change in body shape and reduced muscle mass.
Deterioration in sports ability.
Irritability, moodiness, change in attitude and decreased enjoyment of life.
Generalised aches and pains.
Decreased work performance.