Psychotherapist Jed Diamond started noticing the middle-aged guys around him were getting cranky.
"I'd been doing counseling for a number of years," he says from his home in Northern California, "and what I was seeing in the clients I was working with - as well as some of my friends - was a real change of life that was every bit as significant and hormonally based as what women were going through when they experienced menopause. But I was seeing it in men!"
Then, Dr. Diamond's wife weighed in with her own observation.
"She said, 'You know what? You're having the same emotional ups and downs and physical changes as I'm experiencing. I don't know if there's any such thing as male menopause, but you've got it!'"
That was in the mid-'90s. Today, after years of research, Dr. Diamond has published several books on the subject, including the best-selling "Male Menopause," "Surviving Male Menopause" and "The Irritable Male Syndrome."
There are four major causes of what Diamond refers to as "the change" for men, which typically occurs between ages 40 to 55 and older: fluctuations in brain biochemistry (which is often related to diet), stress, the changing (and sometimes confusing) role of men in today's society and a natural drop in testosterone levels.
Medical doctors frequently use the term "andropause" or "hypogonadism" to describe these age-related hormonal changes in men.
Dr. Donald Hatton, Lawrence internist, sees it often in his practice but says the condition can be challenging to diagnose.
"It's very difficult to know when and if it's coming," explains Hatton, "because many of the symptoms - muscle weakness, irritability, not sleeping well and sexual dysfunction - all have a multitude of causes rather than just a lowering of the serum testosterone.
"Plus, the other difficulty is, if you look at serum testosterones, the range of normal is very large."
Normal testosterone levels range between the low 200s to 900 ng/dL (nanograms per deciliter) and while the numbers tend to decrease as a man ages, the point at which a man will start having symptoms is impossible to predict.
"Many people will have lower serum testosterones and not have any symptoms at all," Hatton points out. "That's because they eat well, aren't overweight. They're not diabetic and not on a multitude of medications. They don't drink alcohol a great deal; they're certain to get their sleep. They have a good relationship with their partner or their wife. They exercise and take care of themselves. Those people seem to do quite well even though they have little or, in fact, many times, no testosterone."
In other men, low levels can cause weakness in the muscles, moodiness and sexual problems like low libido and impotence. And, as in women, osteoporosis (bone loss) is a real concern.
Treatment options
A complete physical examination can help determine the problem and its proper treatment.
"Male menopause, for the most part, is an exclusion diagnosis. You want to be certain there's not some other endocrine problem, or some that is making the testosterone low. You have to be certain the pituitary gland is working properly and that there's not an organic problem with their testosterone-making organs, that they haven't had some injury to their testicles, for instance."
Once an accurate diagnosis has been made, treatment options will vary.
Hatton says, "Before you start hormone replacement therapy, you have to ask 'does this individual have an increased risk for prostate cancer?' because testosterone is the food that feeds prostate cancer."
"If everything else is OK, generally what we do is offer testosterone replacement to make the patient feel better - better muscles, better bones - then, at the same time, offer them a medication to help with sexual function, if that is part of the syndrome."
Brad Grant of King Pharmacy, who provides bio-identical hormone replacements to women and men, says andropause is a growing trend.
"It's something that's beginning to be more prominent because of the aging population, the increase in longevity and, of course, all the baby boomers," he says. "You're seeing many more men that are being affected by this these days."
Facing the stigma
Being affected, however, doesn't necessarily mean men will seek treatment for what some consider an embarrassing problem, or just an inevitable result of aging.
"We see some men coming in" notes Grant. "I think usually it's their wives who ask for them. Men will sit there and say, 'Well, I'm not as energetic. I just don't feel like doing the things I normally do; I don't have any sex drive.' And they shrug it off and think it's just part of the aging process because it comes on so gradually. They don't realize there is something they can do about it. Women are much more proactive about things like that."
Dr. Diamond agrees and reveals it's usually the woman who prompts a man to take action.
"If she approaches him in a way that makes him more receptive - even if he's in denial - then over time she can get through to him," suggests Dr. Diamond. "Once she does, I've found that men are very engaged at wanting to make things better because they don't like being grouchy or irritable. And they're hungry for a way that they can make changes but still feel manly, with their integrity intact."
Comments
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matahari (anonymous) says…
so true, by coincidence I brought this topic up to a male friend this evening. Sadly, it was shrugged off as some sort of "women only" problem.
crazyks (anonymous) says…
Maybe part of the reason that men (and women) feel irritable so much of the time is that society has conditioned them to think there's something wrong with them when they get older and things change...
Why can't society just accept that menopause (whether male or female) is a natural process? Why do we always think we have to pop a pill to "fix" something?
bearded_gnome (anonymous) says…
"Once she does, I've found that men are very engaged at wanting to make things better because they don't like being grouchy or irritable. And they're hungry
for a way that they can make changes but still feel manly, with their integrity intact."
---wrong! who says many men don't like being irritable or grouchy?!?
grrrrrrrrrrrr
SFBayhawk (anonymous) says…
You get old...you die. But at least you don't look goofy walking around attached to a cell phone.
Irish (Leslie Swearingen) says…
Read Cell by Stephen King.
I agree that a lot of people are raised to think in terms of age, and what is age appropriate for them.
People will start moaning about feeling old when they turn twenty-five.
I believe that every stage of life can be positive and fulfilling but it is up to you to make it so.
Just ignore the naysayers.
Having a libido and sex is not necessary for happiness and well being. If you have a demanding spouse that is getting to be a nuisance, well, divorce them.
misplacedcheesehead (anonymous) says…
Irish, you have me laughing when you say"...well, divorce them." Don't know why, but it just strikes me as funny!
I have long believed there was such a thing as male menopause, but I disagree with one thing. I do not believe that men lose sexual prowess when they are middle-aged. And no, not all of them need Viagra, Levitra, or Cialis, either! (grin...)
George_Braziller (anonymous) says…
Uhhhhh, Cheesehead -- I think that Irish or Leslie or what ever name she is going by now is serious.
crazyks (anonymous) says…
I've often wondered why, when a couple gets older and her libido lessens and his does not, why she's always the one expected to fix the problem?
Instead of the woman getting treatment to increase her sex drive (like you'll die without one), why doesn't HE get treatment to lessen his sex drive??
misplacedcheesehead (anonymous) says…
Crazy-no, no, if a woman is lucky enough to have a partner who is well into his 50's and can still, uh, well he doesn't lack for anything, don't take that away from him! (ha,ha)
I think it's very sad when either gender loses their interest in sex. Personally, I think I would figuratively "die" without my sex drive. You see, before 30, sex was terrible. I intend to make the most of it as long as I possible can. Grin....
crazyks (anonymous) says…
I lost most of my sex drive after menopause, and I don't miss it a bit...luckily I'm not in a relationship, so it doesn't matter...
If sex is so important in the relationship that a person is willing to break up with the other if they don't get enough sex, then that is pretty sad, too...and it happens a lot more than some people realize...
For women, one of the ways that they bring back sex drive is to give them hormone treatments...depending on the woman and her medical and family history, that could be dangerous if not downright deadly...what man who truly cares about his spouse would expect her to put her very life in danger just for sex?
Yet that happens all the time, too...and that's sad...
Why can't people accept that it's a natural process, and just let it happen?
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drfred (anonymous) says…
The book, "Irritable Male Syndrome" by Jed Diamond was one of the most eye-opening books I've read in the last few years. I recommend it to my executive coaching clients and their partners in life.
For different perspectives on these issues as they relate to midlife, you may want to visit- happiness-after-midlife.com