The Andropause Mystery: Unraveling The Truths About Male Menopause

An interview with author Robert S. Tan, M.D., MBA

Dr. Robert S. Tan is a renowned Geriatrician who has an interest in Aging Andrology. He teaches at the University of Texas, Houston and is also author of the book: The Andropause Mystery: Unraveling Truths About The Male Menopause.

Q. How can women recognize Andropause in their partners?

A. Men are not spared from Menopause. The Andropause is the time in a man's life when the hormones naturally decline. It can be defined as "a change of life for males that may be expressed in terms of a career change, divorce, or reordering of life. It is associated with a decline in male hormone levels that occurs during their late forties or early fifties." Many have questioned whether the male menopause is more myth than reality. In truth there is an undeniable hormonal decline as one ages, and this in turn aggravates the aging process.

Like Menopause, men suffer from symptoms of the Andropause. Between the ages of 50 to 70, some men report symptoms such as erectile dysfunction (failure to achieve an erection), general tiredness, mood changes, night sweats and sometimes palpitations. Most men attribute erectile dysfunction to be the most significant event of the Andropause. Apart from erectile dysfunction, mood changes can take place too. Some patients of mine have complained of nervousness, irritability and even depression. Other patients undergoing andropausal changes report the feelings of wanting to be closer to family and friends. Men often focus too intently on their career, money and power in their earlier life, often neglecting family and friends. In the andropausal years, men and take on a more "maternal" role, as if transitioning to become more motherly than fatherly. They become more concerned about their friends and family, as if regretting their former attitudes. It is interesting that many patients do not sense these changes in themselves, but rather it is women that notice this and tells me that he is undergoing "the menopause"!

In andropausal men, night sweats and palpitations occur because of an overactive autonomic system in response to falling testosterone levels. It is important not to dismiss or misdiagnose physiological changes related to the Andropause.

Q. How can women get men to go to the doctor?

A. Research demonstrates that men by and large are less likely to see a doctor for any reason. Part of it is because the male psyche where a dependent role is not acceptable. Generally speaking, men tend to focus less on health and more on money, power and status. One strategy to get men to see their doctor is actually to see a understanding and well trained doctor together. Sometimes, the doctor can get a lot more information interviewing couples together. At times, the interviews should be held separately and staggering consult times 30 minutes apart is prudent.

To assess for hypogonadism, which is in part the clinical basis of the Andropause, the doctor will check for the following things in men:

1. Loss of hair in the armpits and axilla
   
   
2. Shrinkage of testicles
   
   
3. Decreased Libido or low sex drive
   
   
4. Erectile Dysfunction or Impotence
   
   
5. Lethargy or tiredness
   
   
6. Depression
   
   
7. Decreased muscle strength
   
   
8. Oligospermia or low sperm count
   
   
9. Decrease bone density

Androgens basically create "masculinity" and the loss of androgens such as testosterone leads to physical changes. Women in their post-menopausal years complain of dryness in their vagina, skin and sometimes even a lowering of the pitch of voice. The dryness in the vagina could result in dyspareunia or pain on intercourse. In men, subtle changes occur in the post-andropausal years. The once dashing looks are now exchanged for something much less eye-catching. Hardened muscle disappears and instead, flabby fat accumulates, as one gets older. This distorts the physique from an athletic "android" to one with a beer belly and little muscle. The skin also gets dry, and there is hair loss. Hair loss occurs not only in the scalp, but also in the genital area as well as in the axilla. The testes also atrophy (get smaller) slowly. There is loss of height because of osteoporosis and the spine gets curved from wedge compression fractures. It is important to realize that testosterone can maintain bone integrity just like estrogens in women.

Q. What can women do to help their men make a smooth transition?

In my book, The Andropause Mystery, I described Six Simple Strategies to Combat Stress in the Andropause. I believe that if women can help their men use these 6 strategies; they would be on their way to a better and complete life together. As the older male ages and undergoes the Andropause, he has to grapple with profound changes and issues. These changes bring about stress, and if stress is not managed well, it can be very disabling and even lead to depression. The 6 strategies for a successful Andropause are summarized below:

1. Teach Men to Love and Reward themselves and others. Much satisfaction can be obtained from not only receiving but also giving. There comes a point in life where leaving legacies behind become important.
   
   
2. Teach Men to Control and Organize themselves. In particular, they should learn not to abuse alcohol and quit smoking. Time management is crucial as well.
   
   
3. Teach Men not to neglect Exercise. A combination of cardiovascular and muscle conditioning will help delay aging processes.
   
   
4. Teach Men to Relax and Rest well. The body is changing with aging and there are physiological changes occurring and that he and you should be mindful of that.
   
   
5. Teach Men to Feed themselves- not quantitatively but qualitatively! It is important to eat the right kinds of food to adjust for physiological aging changes.
   
   
6. Teach Men to Enjoy Aging and the Andropause. Some things are inevitable, no matter what we do! It is important to be satisfied. Most of us will have to pass through this journey so let us make the best of it. May we make this journey of profound change one also of positive evolvement, and a time of rich blessings for ourselves as well as those around us, as we age graciously through the Andropause!

Q. Do you think that the future for men's health will commonly include hormone replacement as it is for women today?

A. I studied 302 men, and one of the questions are asked them was this: "if the doctor told you that your testosterone level is normal, will you still go want testosterone replacement?" Rather surprisingly, the majority of the respondents said "YES". My rationale is that there really cannot be too much of a good thing! Perhaps men perceive hormones like testosterone differently from women. It seems to me that by and large, men want to remain virile and stay away from aging naturally. While some women have delayed the end of reproductive life by the aid of science, it is rare. However, men throughout centuries and across all cultures have taken all sorts of supplements including aphrodisiacs, secretogues, vitamins etc. in an attempt to stay virile. It is interesting that some cultures in Asia have been using the root of a plant for ant-aging purposes. Recently, scientists found that this root stimulates the body's own testosterone production and accounted for some of the anti-aging properties.

I believe men want to be on hormonal replacement, and they need to hear from their doctors that it is safe and effective. There are insufficient large clinical trials to say that hormonal replacement is for all men. Before then, men will continue to use their anti-aging supplements in an attempt to delay their age. Doctors have a responsibility to their patients as their practice is rooted on "evidence-based medicine". At this point, hormonal replacement for men should be considered on a case-by-case basis, depending on symptoms. Over the next decade or two, as more information is available, I do foresee that hormonal replacement will be more routine and perhaps replace some of the self-help regimens that men are experimenting with now.

I would like to thank Dr. Robert S. Tan for taking his time to answer my questions. If there is a man in your life who may be experiencing the symptoms of Andropause, do yourself and him a favor by reading Dr. Tan's eye-opening book, The Andropause Mystery: Unraveling Truths About The Male Menopause which is available for purchase online at Barnes & Noble by clicking the link, or at your local bookstore.