Q: Would you please tell me something about male menopause. Is there a certain age that it starts?
-- G.K., Louisville, Ohio
A: Andropause is a term that's being increasingly used to describe the counterpart to menopause that occurs in men. Andropause is associated with a decrease in the androgen hormones, the best known is testosterone.
Testosterone is the main chemical responsible for the physical changes we see in males during puberty, which includes growth of facial hair, deepening of the voice and increasing muscle mass.
In adult men, changes due to testosterone deficiency include loss of energy, depressed mood, decreased libido, erectile dysfunction, decreased muscle mass and strength, increased fat mass, frailty and bone loss.
But these are the same symptoms associated with aging in general. So it's difficult to determine when the effects are solely due to abnormally low levels of testosterone. One recent study of men seeking care for the symptoms of andropause found that the level of testosterone was not a good predictor of symptoms.
Testosterone is primarily produced by the testicles. This production is controlled by the pituitary gland and a part of the brain called the hypothalamus. Diseases of any of these can cause a reduction in testosterone.
Many experts suggest that there are millions of men, even after adjusting for age, who have lower than normal levels of testosterone in the blood. But these lower levels, for a significant number of men, may be likened to variations of other physical characteristics, such as being shorter than normal in stature, which are not a problem or a reason to be concerned.
Some studies have shown that younger men with significantly lower levels of testosterone do benefit from taking testosterone. But it's not known what the benefits would be for older men who have below-normal levels.
Like any other medication, testosterone has negative side effects in some people. These include increased prostate size, higher levels of cholesterol, breast discomfort, and sleep apnea in overweight men or those with lung disease.
Because this hormone increases muscle strength, enhances energy level, and may improve sex drive and erectile function, many men may think of it as the fountain of youth in a patch (the drug is given as a patch or gel on the skin, although it may also be injected). As more men come to regard testosterone as a wonder drug, and as drug companies recognize a potential multibillion dollar business, doctors will come under a lot of pressure to prescribe more testosterone in the future.
Those who seek potions for everlasting youth, however, are always disappointed. And long-term use of hormones, such as estrogen, have not been has safe as originally thought.
Many experts agree that a large clinical trial, similar to the ones used to determine the risks and benefits of estrogens, should be done before organizations, doctors and patients decide on the best course of action.
It will take many years to get the results from a large clinical trial, and funding may be a problem.