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Aside from too much food and too little exercise, that beer belly could also be due to decreasing testosterone levels, which can result in increased fat deposition. — AFP

Is male menopause a real thing?

Women aren’t the only ones who go through changes in the production of sex hormones as they age – a process known as menopause. Men too experience symptoms of change as time goes by.

There’s even a name for the hormonal changes undergone by men from their forties and onwards: andropause. It refers to the condition of low testosterone, a feeling of decline in wellbeing and a lowered sex drive.

It’s often spoken of as a counterpart to menopause. However, it isn’t really the same thing. Unlike women, the male reproductive capacity doesn’t end when they go through andropause. Rather, men go through a decline in androgen levels and some decrease in spermatogenic function due to ageing.

Hence, instead of andropause, doctors prefer to call the symptoms that men go through “partial androgen deficiency of the ageing male” (Padam). These changes are inevitable and can affect individuals differently. Regardless of the symptoms, it’s important to remember that going through Padam is a natural process and not a disease.

Slow and subtle

In men, the decrease in sex hormone production is less discernible than in women. It takes decades to develop, rather than months or years. Because the physical and mental changes occur so subtly, they can be easily missed or overlooked.

The sex hormones that cause men to experience changes beginning in their forties are known as androgens. They are steroid hormones with specific effects on tissue growth (muscle, fat, skin, hair and others) and brain function.

Androgens are important for women too, but men have them in larger quantities. After puberty, the bulk of androgens are produced by the testicles, primarily as testosterone. Other androgens – i.e. dehydroepiandrostenedione (DHEA), its sulphate (DHEAS), and dihydrotestosterone (DHT) – are produced in the adrenal cortex, skin and liver.

A blood test can confirm if someone is androgen deficient. The lowest point of a normal testosterone range is about 300 nanograms per decilitre (ng/dL) and the upper limit is around 800ng/dL. In general, levels below 300ng/dL, combined with symptoms, are indicators of a testosterone deficiency.

However, there is widespread disagreement amongst the medical community over what is the normal range of testosterone levels, and what exactly should be measured in the blood to assess androgen deficiency. Thus, Padam is currently diagnosed based on evidence of reduced testosterone via a blood test, along with the presence of other clinical symptoms.

These symptoms include:

  • Decreased sex drive
  • Body hair loss
  • Erectile dysfunction
  • Reduced muscle mass and muscle strength
  • Increased fat deposition
  • Lack of motivation
  • Short-term memory loss
  • Depression
  • Fatigue and reduced energy levels
  • Nervousness
  • Decreased bone density.

Androgen deficiency can also occur in younger men, and even in children and adolescents, due to conditions like testicular damage, genetic disorders or metabolic disorders. These individuals should receive expert assessment by a healthcare provider trained in prescribing hormone therapy and start to receive androgen replacement therapy as soon as possible.

Treat the symptoms

Presently, most doctors don’t consider Padam a serious condition and do not typically offer a course of treatment. If you believe you are going through Padam, see a doctor who will take your concerns seriously and take a practical approach to your symptoms.

Get a blood test to determine the state of your testosterone levels. If they are on the lower end of the range and multiple symptoms of Padam are present, treatment options can be considered. Try a therapeutic trial of testosterone supplement therapy for up to three months.

If your symptoms are not alleviated, then continuing treatment may not be worth it, even if blood tests indicate that your testosterone levels have risen. Blood tests should also be done to check the levels of other hormones, such as prolactin, follicle-stimulating hormone (FSH), luteinising hormone (LH), oestradiol, progesterone, DHEA, cortisol and thyroid.

Note that a very high placebo response to treatment can often occur, so it is important to check that any improvements are maintained over time.

Testosterone supplements are available as:

  • Injections
  • Patches
  • Capsules or tablets
  • Gels
  • Implants
  • Transdermal cream with bioidentical testosterone.

Each of these types of supplements have their advantages and disadvantages. Capsules are easy to consume, but do not always provide steady hormone levels. Patches are probably the easiest form of testosterone to use, but are fairly expensive.

To get a prescription for these supplements, you’ll need to see a specialist certified for hormone therapy, as a general practitioner (GP) is unlikely to recommend them. Individuals who are receiving testosterone supplements should have regular medical checks.

This is as these supplements can also raise a man’s red blood cell count and enlarge his breasts. It was also initially thought to accelerate prostate growth and increase the risk of prostate cancer. However, research by American consultant urologist Dr Abraham Morgentaler showed that this decades-old belief was incorrect.

The founder and director of Men’s Health Boston and associate professor at Harvard Medical School pioneered the modern use of testosterone in men. More recent research also shows that testosterone is beneficial to men in many ways, including sexually, physically and cognitively, as well as improves their mood.

Testosterone decreases the risk of diabetes, metabolic syndrome and obesity; can stave off dementia; and improve overall quality of life. So, for men experiencing symptoms of Padam, do have a chat with your doctor and explore all available options before making a decision.

By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 15 Nov 2021

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