Perhaps There's a Reason It's Called 'Men'opause Is a Male 'Change of Life' Fact or Fiction?

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By Jeanie Davis
WebMD Medical News

Reviewed by Dr. Dominique S. Walton

When Kerry Bell hit his mid 40s, life just wasn't acceptable any more. "There was this huge dissatisfaction. ... I didn't like the way my life was going. Sexually, I didn't have the 'stamina' I used to have, if you know what I mean. ... And then I realized I might have another 30 or 40years of this," he tells WebMD. "I had to do something."

His wife Nancy remembers it well. "He became emotionally high maintenance," she tells WebMD. "He had been doing the same kind of work for a long time. He wanted to move in a different direction, but wasn't really sure how to do it. It was difficult ... he was challenging everything he thought was true about who he is."

We used to call it "midlife crisis" this transitional period when men run off with a young beauty, when they start buying all the toys they never had as young men, says author Jed Diamond in his newly released book, Surviving Male Menopause. Today, it's being labeled "male menopause," as research shows the hormonal and physiological changes that men like women experience as they move through the crucial midlife period.

In his book, Diamond shares insight and case studies from his 35 years as a clinical psychotherapist and director of Men Alive, a health center in northern California. He also details his personal journey through midlife, his bout with depression, and his efforts to keep his marriage intact.

"Clearly, there is the psychological part of male menopause, the feeling that time's running out, the feelings of depression, anxiety, that maybe I need to go back to my lost youth and feel more manly or sexy," Diamond tells WebMD. "These are men couples who are through with the day-to-day childrearing, so it should be a time for enjoyment. Yet, their relationships often break up because of the stresses. I want to help people understand what's going on, show them that relationships don't have to deteriorate."

In truth, male menopause is much more complex than mere psychological wear and tear, much more than marital woes, Diamond says. "There's also a sexual component, physical and hormonal changes, and these all interact together," he adds. "When men hit menopause, there's a multidimensional change that prepares them for the second half of their lives."

Diamond says research into male "change of life" is relatively new a spin-off from studies of women's menopause. "In Europe, it's been studied much longer ... as long as 40 years," he tells WebMD. Diamond is helping orchestrate an international conference, scheduled for later this month, bringing together the world's top researchers on male issues.

Male menopause is "puberty in reverse," he says. And to some degree, all men go through these changes, Diamond tells WebMD. "It's just more dramatic in some men. Some have more symptoms than others."

In his research, Diamond says he saw striking differences and to his surprise, similarities between what men and women go through during menopause. "... Even hot flashes," he tells WebMD. "A lot of women say that when men start having hot flashes, they will take the idea of male menopause seriously. I've gotten literally hundreds and hundreds of letters from men, 50yearold businessmen, executives sitting in a business meeting when all of a sudden they're turning beet red and profusely sweating, even though the air conditioning is on. Hot flashes are obviously not as common in men as in women, but they do happen."

Diamond also found research indicating that lowered levels of hormones including growth hormone, testosterone, and the related hormone DHEA may decrease sex drive, increase depression and weight gain, and contribute to a general decrease in well being and health. Although the hormone levels decrease with age, individual levels will vary widely, Diamond says.

Bell made it through his crisis, emerging with a job that suits him better, a new woodworking workshop, and an intact marriage as well as reading glasses, too much weight, and a memory that's not as reliable as before. He's also got an improved attitude about his life, taking it more in stride, he says, thanks in part to a support group: "Life is what you make it." As for testosterone therapy, that's not even a consideration, he says. "That's just not for me," he tells WebMD.

It is true that "men don't escape entirely unscathed from the aging process," says Richard Spark, MD, associate clinical professor and an endocrinologist at Harvard Medical School and author of Sexual Health for Men: The Complete Guide.

As a man hits mid stride, Spark tells WebMD, "his testicles continue to generate adequate amounts of sperm albeit less than they did as a younger man. They continue to make testosterone albeit less than they did at a younger age. And the production of testosterone while not as vigorous as before is good enough to get the job done in the vast majority of
cases. So it can maintain libido and sex drive and potency in the vast majority of
men as they age."

But so-called male menopause "is just not the same for men as it is for women," Spark tells WebMD. "The vast majority of men do not experience a loss of testosterone production comparable to the total loss of estrogen as occurs in women. As a result, they don't, as a general rule, experience hot flashes. Hot flashes in men mostly occur when there is complete loss of testosterone ... when there's gonadal failure, when he has a pituitary problem, or when he's getting treatments for [widespread] prostate cancer."

For men, hormone replacement therapy is not a clear-cut answer, Spark tells WebMD. "If you take a man who is down in the dumps and give him testosterone, he may or may not get better. And you may put him at risk of stimulating prostate cancer growth. But if you treat him with an antidepressant, his moods will get better."

The benefits of hormone replacement therapy for women are more evident, he adds. "Women will describe certain changes in mood that will disappear, hot flashes will go away. If you take away the medication, the symptoms come back."

Men's sexual problems generally are more complex, Sparks says. "You need testosterone to maintain libido. If testosterone is absent, one of the major things you see is lack of libido. The ability to have erections is a vascular phenomenon; you need blood to flow into specialized chambers in the penis. So with men who have had a history of [heart] problems and heart attacks, you'll have problems with blood flow to the genitalia.

Another expert recommends testing for men around age 45 or 50 who have symptoms of "male menopause." John Campbell, MD, assistant clinical professor at Ohio State Medical Center and Hershey Medical and a preventive medicine specialist at the Cleveland Clinic, tells WebMD, "A very small drop in testosterone 10% or so might cause symptoms like depression, mood swings, decreased muscle strength and energy, reduced sex drive, problems with erections." If the level is low, and there is no other problem (like a
pituitary disorder), it might be time to have a discussion about testosterone therapy, he says.

But seriously consider the risks for prostate cancer, blood pressure, and [heart] disease, he says. "It could predispose someone to prostate cancer. If you do have cancer, it [testosterone] would stimulate that cancer," Campbell says. "It's not a benign drug."

Too much is unknown about hormone replacement therapy for men, says Stanley
Slader, MD, deputy associate director of geriatrics at the National Institute on Aging. "People who believe that testosterone therapy will help, [they] talk about bone and muscle and energy level and sexual behavior/libido ... and those are certainly possibilities. But all these things have not yet been demonstrated.

"The great mass of men have somewhat lower testosterone as they age, but it's still within normal range," Slader tells WebMD. "But are there any health problems that relate to the lower testosterone levels that can be improved with testosterone? The answer is, we don't know."

There have been a small amount of studies on the subject that has left Slader with the feeling that "there's a lot that remains to be seen here. ... Any older man who doesn't have the zip he once had, maybe he feels a little depressed, doesn't have the strength he used to have, whose joints creak a little, who would like to jump out of bed and be 20 again ... there's not a lot in the scientific literature to support that giving him testosterone will be the answer," Slader tells WebMD. "They're just getting older, and with age come a whole host of changes in the body and age associated diseases." As for midlife relationship problems, Slader says with a chuckle, "that's just people not getting along. Call a psychiatrist"