Male Menopause – fact or fiction?

Male behaviour is to a large extent driven by testosterone. It’s therefore logical that the age-related decline in testosterone levels with age will bring about corresponding symptoms. However, the concept of male menopause is rarely considered as a potential cause of the physical and psychological changes that occur in men as they age.

Menopause in women is responsible for many changes, both physiological and psychological, that occur as oestrogen levels fall and the menstrual cycle winds down. These effects are well known and researched, but the effects of declining testosterone are not nearly so well understood or accepted.

Physiologically male behaviour is to a large extent driven by testosterone. Is it not logical that as testosterone declines with age there will be a corresponding price to pay?

INCREASING STRESSES

It is important to understand the importance and relevance of ‘biochemical individuality’. All of us have our own set of genetic codes, which means that we are programmed to respond uniquely to differing situations and circumstances. This genetic blueprint is influenced by the ‘ebb and flow’ of life – our exposure to ‘life shocks’, the influence of parents, teachers and peers, and so on. These life experiences equip us, well or not so well, for survival in what is often a harsh world.

For this reason individual responses to physiological changes range from mild through moderate to severe. Because the world of research is essentially dominated by men and the male brain favours a logical, analytical approach, when the pieces of the puzzle don’t fit into an organised, logical and repeatable picture, attributing an often nebulous, multi-faceted symptom profile to a single diagnosis is viewed with scepticism and disbelief.

This is pretty much how male menopause is viewed. It is accepted that something often causes an uncharacteristic change in male behaviour around the age of 40 to 50 years. It may be much later, even at 60 – but it happens. In the absence of any ‘hard’, demonstrable clinical findings, the catch-all diagnosis of ‘stress’ is resorted to.

It is important to understand that the body is in a constant state of change – physically, mentally, spiritually and emotionally. While many of the stresses we face on a day-to-day basis are not new, in the modern world there are different and perhaps more insidious influences on our ability to cope. Just a few of these are the effects of pollution and xeno-oestrogens, the ever-increasing speed of life, advertising, competition with peers, personal expectations, interracial conflict and relationship challenges. It is almost as though we are becoming more fragile and vulnerable, and the body has not evolved quickly enough to cope effectively with the multiple and multifaceted types of stress each of us are exposed to.

When discussing the variable forms of male behaviour, especially those associated with advancing years, two concepts need to be addressed: midlife crisis and true male menopause (also known as andropause, late-onset hypogonadism, or androgen decline in the ageing male).

MIDLIFE CRISIS

In Wayne Dyer’s book Manifest Your Destiny he writes about the four stages of adult male development: the Athlete, Warrior, Statesperson and Spirit. I think most men will identify with these stages, although to differing degrees.

The Athlete phase is when our primary identification is with our physical body. During this phase men measure worth and happiness by physical appearance. This is the time when the ego really starts to ‘flex its muscles’, when life seems impossible without a mirror and a steady stream of approval and positive strokes.

The second phase, the Warrior phase, is when the flexed ego really comes into its own – the primary goal seems to be to conquer the world and to show superiority. It is the time dominated by competition, achievement, and the acquisition of cars, clothes, houses, boats and so on.

With the advantage of maturity, the Statesperson phase gradually begins to unfold. This is a ‘been there, done that’ phase. The intensity of the ego becomes more subdued. The needs, wants and desires of others start to become more important. Arriving at the Statesperson phase unfortunately often takes a long time, and occasionally it only manifests in the very late or even final stages of life. However, ‘arriving’ does not mean that aspects of the Athlete and/or Warrior aren’t still evident. It is just that the inner desire has shifted from self-absorption to being of service to others, and considering their thoughts and feelings.

Finally, and ultimately, the goal is to reach the state of Spirit – where one recognises one’s truest essence, the Highest Self.

I mention these stages because the transition through each can precipitate conflict and confusion. Even if a man consciously or subconsciously wants to experience the ‘feeling’ of moving into what may be considered a higher level of functioning, life may almost demand that he stays in the Athlete or Warrior phase. In order to cope with this conflict, the body does what it does best and strives to establish homeostasis. It does this by producing noradrenaline, the ‘neurochemical of adaptation’, as I call it.

All of this takes place against a background of increasing financial burdens, worries about the future, inability to enjoy leisure time because of work and family commitments, testing relationships, negative evaluation of work and personal life, an overriding feeling that life is no longer as exciting as it used to be, questions about the meaning of life, feelings of wanting more adventure from life, and unfulfilled dreams. Is it any wonder then that one feels that one’s heading for a crisis, and is prepared to do anything to avert the impending doom?

Having said this, should we perhaps not be asking ourselves the question, ‘why’? Why is a magnificently constructed, self-healing organism behaving in a way that creates such turmoil?

Certain things in life are definite, and one of them is change. The very nature of the world we live in is such that there is constant evolution. Could it be that the universe, in its unique way, is attempting to show us that the early stages of emotional development, the Athlete and the Warrior – often much more dominant in men than women – in fact detract from innate male/female equilibrium?

The physiological changes of noradrenaline overload:

• By up-regulating the musculoskeletal system, it causes muscle tension, headaches, neck pain and back pain.
• By up-regulating the cardiovascular system, it results in heart palpitations, anxiety, an increased heart rate and raised blood pressure.
• By down-regulating the digestive system, it causes irritable bowel syndrome, spastic colon, food allergies, and constipation or diarrhoea.
• By down-regulating the reproductive system, it results in decreased sexual ability and reduced libido.
• By down-regulating serotonin, it causes lack of motivation and enthusiasm, decreased productivity and negative mood.

A growth experience

It is almost as if the conscious mind, bombarded by ‘real-world’ stimuli, competition, fancy cars, bigger and better houses, prettier and more exciting partners, gets to the point of understanding that these external ‘crutches’ are just that and really have no long-term true satisfaction potential. A certain amount of maturity, understanding and experience is required to grasp this concept. I believe that at a cellular level each of us is well aware of how little true satisfaction, if any, the superficial ‘crutches’ really provide, and it is only once we can identify with our true ‘essence’ that we start to experience and truly enjoy life.

Crossing this space with dignity and integrity is often the challenge, and will in many instances require a great deal of introspection. There is absolutely no doubt that this process is a ‘growth’ experience, and is it not true that with growth one often experiences pain? If one is able to manage the transition constructively the benefits can be enormous. However, dealing with this process often requires the assistance of a trained therapist, and I can only encourage individuals starting to experience the twinges of a midlife crisis to recognise the symptoms quickly and act upon them.

TRUE MALE MENOPAUSE

The second consideration is the inevitable effects of decreasing levels of male sex hormones (androgens), especially testosterone. This is a normal physiological process of ageing in men, as it is in women when oestrogen levels decline.

It is estimated that testosterone production drops by 10% per year after the age of 30. The signs and symptoms related to this drop can be subtle and can literally sneak up on one. Unlike noradrenaline, which is produced in response to life events, reduced testosterone is unavoidable – it’s going to happen and the signs will manifest, but the intensity of the signs will vary depending on each individual’s biochemical makeup.

The insidious nature of declining testosterone is such that the individual often can’t understand why he is no longer able to ‘keep pace’ in many different spheres of his life. This precipitates a huge feeling of insecurity and anxiety, obviously causing more noradrenaline production and stress.

The body again tries to compensate for this. Cholesterol is the precursor building block for the manufacture of testosterone. With declining testosterone the body starts to produce more and more cholesterol, resulting in rising levels. Present any of the above-mentioned symptoms to your doctor, and often a routine cholesterol test is done, showing elevated levels. Cardiovascular risk is diagnosed and cholesterol-lowering medication is prescribed, which actually further exacerbates the condition because of the reduced available substrate (cholesterol) for the manufacture of testosterone.

So why is the concept of male menopause so poorly understood and accepted? Three reasons seem to predominate:

1. Historical factors. Early hormonal treatment was, at best, dubious. Oral testosterone, in the form of methyl-testosterone, was toxic to the liver and heart.
2. Medical factors. Total testosterone was found to be low in only a small percentage of patients with symptoms, therefore refuting the connection. It was only with improved techniques and measurement of the free androgen index that the extent of the problem began to emerge.
3. Image factors. The name of the ‘condition’ met with resistance, even when couched in fancy medical terminology, and the diagnosis of male menopause or hypogonadism brought with it a stigma that no man was happy to accept.

So in the final analysis, it is now fairly well accepted that there are numerous challenges facing men as they age – stress challenges that up-regulate noradrenaline and cause many physiological problems, and decreasing testosterone levels that cause both physiological and psychological symptoms. Both states can be severe enough to precipitate anything from severely abnormal behaviour to mild hiccups in normal functioning.

SIGNS AND SYMPTOMS

Signs and symptoms of declining testosterone levels include:

• decreased sexual prowess and libido and an increasing incidence of erectile dysfunction
• increased feelings of fear, not being able to cope, and nervousness
• sleep disturbances
• weight gain, decreased muscle tone and increased fat
• irritability, indecisiveness and depression
• hair loss and greying hair
• a longing for intimacy, but a fear of being close.

TREATMENT

Managing a midlife crisis can include use of relaxation techniques, massage and reflexology, passive exercising such as yoga and tai chi, meditation and lifestyle coaching. The effects of falling testosterone levels can be improved.

Other treatments include:

• natural hormone replacement therapy and the use of glandular extracts
• a healthy diet (high-fibre fruits, vegetables, and grains)
• detoxification (liquids-only diet, psyllium husk powder, and digestive enzymes)
• herbal medicine
• homeopathy
• exercise.

Consultation with a health practitioner well versed in the signs and symptoms attributed to male menopause can result in significant improvement in one’s state of wellbeing, confidence, happiness, motivation and enthusiasm.