Male menopause: Myth or reality?

Sometimes called male menopause, aging-related hormone changes are very different in men than in women. Learn about symptoms and treatment.

Less interested in sex lately? Tired? Grumpier than usual? Is this a midlife crisis brewing? Or are you feeling the normal hormone changes associated with aging? Hormone changes are a natural part of aging for men. But male menopause is not an accurate description. Unlike the more dramatic hormone plunge that occurs in women during menopause, hormone changes in men occur gradually, over a period of many years, the effects of which are often subtle and not noticed until much later in life. Some men are never affected by lower hormone levels at all — while some have physical and psychological symptoms that can include changes in sexual function, energy levels or mood.

While the term "male menopause" is sometimes used to describe decreasing testosterone levels related to aging, Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn., prefers the term "andropause." "There needs to be a distinction because we're dealing with two different situations," he says. "In women, ovulation ceases and female hormone production plummets over a relatively short time frame. In men, there's a gradual decline in the production of male hormones." Age-related decline in testosterone levels are also called testosterone deficiency, androgen decline in the aging male (ADAM) or late onset hypogonadism (LOH).

Male hormones over time

In general, older men have lower testosterone levels than do younger men. After age 40, testosterone levels in the blood begin to decline gradually — at a rate of about 1 percent a year. While there's a steep drop between the ages of 45 and 50, reduction in testosterone levels are rarely significant enough to be noticeable in men younger than 60. By the time men reach their 80s, about half have low testosterone. But testosterone levels vary greatly among men — and some men maintain normal testosterone levels into old age. Other men who have low testosterone levels don't have bothersome signs or symptoms.

What are the symptoms of andropause?

Lower than normal testosterone levels do not cause symptoms in all men — and signs and symptoms of low testosterone vary from person to person. Some of these signs and symptoms are a normal part of aging. The only sure way to know whether you have low testosterone levels is through blood tests.

Signs and symptoms of low testosterone can include:

• Reduced sexual desire
• Infertility
• A decrease in spontaneous erections (such as during sleep)
• Swollen or tender breasts (gynecomastia)
• Loss of body and pubic hair
• Small or shrinking testes
• Height loss and thinning bones
• Reduced muscle bulk and strength
• Hot flushes and sweats

Other signs and symptoms can include:

• Decreased energy, motivation and self-confidence
• Feeling sad or depressed
• Poor concentration and memory
• Sleep apnea or other sleep problems
• A low red blood cell count (mild anemia)
• Increased body fat
• Diminished physical or work performance

Testosterone replacement therapy

Treatment of low testosterone due to aging with testosterone replacement therapy (TRT) is controversial. The benefits of TRT are not clear, and it may increase the risk of prostate cancer. While certain men who have symptoms related to abnormally low testosterone may benefit from testosterone replacement therapy, it isn't appropriate treatment for most aging men. While it has been shown to help some men with low testosterone, TRT has risks, especially for men with certain health conditions such as prostate cancer and heart disease — and it may not improve your symptoms. More studies need to be done to determine the effectiveness and safety of TRT in aging men, and who can benefit most from this type of treatment. As it turned out with hormone replacement for women, TRT may have possible long-term risks that are not yet known.

Herbal supplements: Do they work?

Although many herbal supplements are widely marketed with the claim that they can relieve symptoms, none has been proved safe and effective for aging-related low testosterone. One of the most common supplements marketed to treat this condition, DHEA, may increase the risk of prostate cancer. More studies are needed to evaluate possible health benefits — and dangers — of taking DHEA or other supplements. Talk with your doctor before taking any herbal supplements, as some can cause side effects or cause problems with medications.

Is it low testosterone — or is it something else?

Symptoms caused by testosterone deficiency are similar to symptoms caused by other things. Signs and symptoms can include:

• A number of other health problems such as liver disease, kidney failure, or an overactive or underactive thyroid
• Side effects of medications
• Lifestyle choices such as excessive alcohol use or use of illegal drugs
• Psychological conditions, such as depression or emotional distress related to life changes that come with middle age (the so-called midlife crisis)

Steps that may help

While there's no way to avoid lower testosterone levels caused by aging, there are a few things you can do to help prevent or improve symptoms caused by the condition:

• Eat right and stay active. Regular exercise and a healthy diet can help you maintain your strength, energy and lean muscle mass. It can also improve your mood and help you stay sharp as you get older.
• Talk to your doctor about sexual problems. Erectile dysfunction and other sexual issues are common as men get older. Your doctor can help you find the best way to cope. Medical treatment, lifestyle changes or changes to the dose or types of medications you take may help.
• Seek help if you feel down. Many older men suffer from depression. It often goes undiagnosed — but treatment can make a big difference in how you feel. Depression in men doesn't always mean having the blues. You may have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working all the time, drinking too much alcohol, using street drugs or seeking thrills from risky activities.

If you are an older man and you have bothersome symptoms you think might be caused by low testosterone, see your doctor to get a firm diagnosis and find out your treatment options. While low testosterone does cause signs and symptoms in some men, your symptoms may be caused by normal aging or something else. Identifying and treating other health issues that can cause or worsen symptoms, making lifestyle changes, or changing the type or dose of medications you take may be enough.

Mayo Clinic

Obesity Linked to Prostate Cancer Death Rates

Researchers aren't sure why mortality may be tied to weight

MONDAY, Nov. 12 (HealthDay News) -- In another sign that too much weight spells health problems, new research suggests that fat men are twice as likely to die after being diagnosed with prostate cancer than men of normal weight.

The research doesn't confirm a cause-and-effect link between obesity and a higher risk of death from prostate cancer, and it's not clear if losing weight would help patients after they're diagnosed with the disease.

Still, "if you look down the list of factors that are most predictive of a bad outcome, this [excess weight] ranks up there pretty high," said study co-author Dr. Matthew R. Smith, an oncologist at Massachusetts General Hospital in Boston.

According to the Prostate Cancer Foundation, the disease strikes one in six American men and is the most prevalent form of non-skin cancer in the United States. Risk rises with age, with more than 65 percent of all cases diagnosed in men over the age of 65.

However, prostate cancer can successfully be treated in many cases, particularly if it's caught early.

In the new study, Smith and his colleagues examined the results of men with advanced prostate cancer who were enrolled in a drug study between 1987 and 1992. The researchers looked at 788 men whose weights were recorded at the time of diagnosis to see if their body mass index -- BMI, a ratio of weight to height -- affected their risk of dying.

The researchers found that 6.5 percent of men with normal or low weight -- a BMI of less than 25 -- died from prostate cancer within five years. But the death rate for overweight men (a BMI of 25 to 30) was 13.1 percent, and it was 12.2 percent for obese men (a BMI of 30 or higher).

The higher rate of death remained constant even when the researchers adjusted their findings for other possible factors.

The study results are published in the Nov. 12 online issue of the journal Cancer.

It remains unclear why there might be a link between obesity and death rates from prostate cancer. It's possible that metabolism rates in heavy men might make the cancer more aggressive, Smith said, or obesity could render treatments less effective.

Dr. Martha K. Terris, a professor of urology at the Medical College of Georgia, who's familiar with the study findings, said hormone balance could be another factor. "Obesity changes the proportion of estrogen and testosterone in the blood, and this change may impact on the cancer behavior," she said.

Terris added that "obese individuals generally eat more high-fat diets with less fruits and vegetables that could contain key vitamins that help control cancer growth."

For now, Smith said, "the part we can't know is whether improvements in lifestyle intervention after prostate cancer diagnosis would improve outcomes."

Still, it would be wise for doctors to tell their patients about the apparent link between weight and prostate cancer death rates, Smith said. "This may be a teachable moment that prompts a discussion about general health considerations," he said.

In a related study published in Cancer, University of Michigan researchers found that families coping with prostate cancer reported improved quality of life from a structured support program integrated into the patients cancer management. The study, led by Dr. Laurel Northouse, found that patients and their spouses who participated in a five-session home counseling program reported significant improvement in such areas as symptom management, hope, uncertainty and the couples' communication.

HealthDay

High Blood Pressure and Hypertension

What is blood pressure?

Blood pressure, measured with a blood pressure cuff and stethoscope by a nurse or other healthcare provider, is the force of the blood pushing against the artery walls. Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure as the heart contracts. One cannot take his own blood pressure unless an electronic blood pressure monitoring device is used. Electronic blood pressure monitors may also measure the heart rate, or pulse.

Two numbers are recorded when measuring blood pressure. The higher number, or systolic pressure, refers to the pressure inside the artery when the heart contracts and pumps blood through the body. The lower number, or diastolic pressure, refers to the pressure inside the artery when the heart is at rest and is filling with blood. Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury). This recording represents how high the mercury column is raised by the pressure of the blood.

High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke (brain attack). With high blood pressure, the arteries may have an increased resistance against the flow of blood, causing the heart to pump harder to circulate the blood.

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has determined two levels of high blood pressure for adults:

• Stage 1
  • 140 mm Hg to 159 mm Hg systolic pressure-top number

    and

  • 90 mm Hg to 99 mm Hg diastolic pressure-bottom number
• Stage 2
  • 160 mm Hg or higher systolic pressure

    and

  • 100 mm Hg or higher diastolic pressure

The NHLBI defines prehypertension as:

• 120 mm Hg - 139 mm Hg systolic pressure

  and

• 80 mm Hg - 89 mm Hg diastolic pressure

The NHLBI guidelines define normal blood pressure as follows:

• Less than 120 mm Hg systolic pressure

  and

• Less than 80 mm Hg diastolic pressure

These numbers should be used as a guide only. A single elevated blood pressure measurement is not necessarily an indication of a problem. Your physician will want to see multiple blood pressure measurements over several days or weeks before making a diagnosis of hypertension (high blood pressure) and initiating treatment. A person who normally runs a lower-than-usual blood pressure may be considered hypertensive with lower blood pressure measurements than 140/90.

What are the risk factors for high blood pressure?

Nearly one-third of all Americans have high blood pressure, but it is particularly prevalent in:

• persons with diabetes mellitus, gout, or kidney disease.
• African-Americans (particularly those who live in the southeastern United States).
• persons in their early to middle adult years; men in this age group have higher blood pressure more often than women in this age group.
• persons in their middle to later adult years; women in this age group have higher blood pressure more often than men in this age group (more women have high blood pressure after menopause than men of the same age).
• middle-aged and elderly people - more than half of all Americans age 60 and older have high blood pressure.
• persons whose parents or grandparents have/had high blood pressure.
• obese people.
• heavy drinkers of alcohol.
• women who are taking oral contraceptives.

How does blood pressure increase?

The following may contribute to an increase in blood pressure:

• being overweight
• excessive sodium intake
• a lack of exercise and physical activity

How is high blood pressure controlled?

Many people can control high blood pressure by:

• choosing foods that are low in sodium (salt).
• choosing foods low in calories and fat.
• choosing foods high in starch and fiber.
• maintaining a healthy weight, or losing weight if overweight.
• limiting serving sizes.
• increasing physical activity.
• practicing moderation if consuming alcoholic beverages.

However, other people must take daily medication to control hypertension. People with hypertension should routinely have their blood pressure checked and be under the care of a physician.

Always consult your physician for more information.

University of Virginia