If you think only women experience the uncomfortable symptoms of menopause, think again.
Experts say erectile dysfunction, tiredness, low sex drive and even middle-age paunch can be telltale symptoms of male menopause or andropause.
Four million U.S. men may be affected, according to a study in the New England Journal of Medicine in January.
"There's probably a lot more than we think," said Dr. Robert Waldbaum, chairman of the department of urology at North Shore University Hospital in Manhasset. "If we had a good test for the level of active testosterone that works in the body, then we would be able to diagnose a lot more men and help a lot more people through this aging process."
"Testosterone is the major male hormone," said Dr. Craig Niederberger, chief of the division of andrology at the University of Illinois in Chicago. "It makes guys virile. We call it an androgen or an anabolic steroid, meaning one that builds up the body. It gives them muscle mass, libido, keeps them from becoming depressed, gives them energy and dense bone structure. In a certain odd sense, it's the male equivalent of estrogen, but it acts opposite. Testosterone makes the guy a guy. Estrogen makes the woman a woman."
In females, estrogen levels drop rapidly, bringing menopausal symptoms, such as vaginal dryness, hot flashes and mood swings. In men, menopause is more gradual. Testosterone levels start to decline around age 30 and drop at a rate of 1 percent per year thereafter, said Dr. John Morley, an endocrinologist and chairman of the division of geriatric medicine at Saint Louis University School of Medicine in St. Louis. When testosterone levels drop far enough, it can cause low sex drive, anemia, depression, and emotional, psychological and behavioral changes.
"Some men age, and their testosterone levels stay the way they were all along. There are men whose testosterone is low who can still produce sperm to fertilize women," Waldbaum said. "It's not the clear definition that female menopause is."
"Many people we see tend to find they don't do as well in sports," Morley said. "Their golf game is off. They lose height because of osteoporosis. They're not as strong as they were. They're not thinking well. That's been shown in controlled studies."
Although controversial, testosterone replacement therapy is widely available. It carries the potential for serious side effects, including infertility and acceleration of tumor growth if prostate cancer is present. In the past, the only option was weekly or monthly injections. "The downside was you would have a sudden increase that dropped down precipitously," said Dr. Bruce Gilbert, a urologist in Great Neck. "You would have highs and lows, and it wouldn't be as your body would normally produce it."
Now, men find relief in an assortment of gels, creams and testosterone patches that help in increasing testosterone levels. Some men say the improvement is remarkable. "It's difficult to capture, but the men who take it say they feel much better, and when they stop taking it, they feel terrible," Morley said. "Overwhelmingly, it improves your enthusiasm for sex and your sex life. A number of my patients say their golf game is improved, and that they hit a baseball better and farther. Others say it's not worth it."
Robert, a 72-year-old male from Nassau County, who doesn't want his last name used, has been taking testosterone for the past five years. "It keeps me energetic. I take it so I don't sit in a chair and stare into space. I take it to avoid the feeling of malaise and fatigue."
Doctors believe the effect may be psychological, as well as physiological. According to Dr. Barry Shepard, a urological surgeon with Winthrop-University Hospital in Mineola, "When a guy has no sex drive and his erections are poor and we say, 'we found the reason; you have low testosterone, and we're going to replace it,' after a week they tell me they feel great. Physiologically, that's impossible, but there is some psychology to this."