Lifestyle - What makes men pause

Vijay Nagaswami

This column generates a lot of e-mail, most of which are of too personal a nature to share. However, there are a couple of regular correspondents who continually bewilder me since they seem to feel that I am pro-women and anti-men. I cannot understand what in my writings, leads them to such a conclusion, for being an unapologetic member of the male species, I cannot recall saying or doing anything to fuel such a speculation. However, I hope their concerns are laid to rest by today’s piece, for it is exclusively about men and a distressing experience that they tend to undergo, adding even more to the burdens they inevitably have to carry into middle age.

It is now an acknowledged fact of life that women, in their late forties or early fifties, go through a troublesome period (pun unintended) of hormonal transition accompanied by irritability, mood swings, hot flushes, capricious menstrual cycles and unpredictable behaviour, collectively referred to as the menopause. This kind of transition, it was believed, did not happen in men, because men did not have a discernible menstrual cycle. In the 1940s though, a definite period of transitional symptoms was described by medical scientists and researchers as occurring in men in the 40 to 55 age group.

Researchers struggled to name the phenomenon and referred to it as male menopause or the male climacteric or worse, PADAM (Partial Androgen Deficiency in the Ageing Male), all of which sound either too clumsy, too esoteric or too pejorative, as a result of which men with such transitional symptoms just further stiffened their collective upper lips and ‘manfully’ rode things out until life returned to normal again. In recent times however, a new term has begun to find universal acceptance: Andropause.

Vague symptoms

One of the reasons why Andropause was not seen as a clinically distinct phenomenon was the vague symptoms that it manifested with. Typically, men in the 40-55 age group (rarely men in their late thirties too) slowly become irritable and grumpy. They experience mood swings and feelings of sadness. Attributing these problems to adverse circumstances in the environment, they may blame their jobs, their partners or the pressures of family life. There is also a general loss of energy, initiative and vitality. Their muscle mass decreases a bit despite pumping the same quantity of iron as always and they also experience back pain and aches all over their bodies. The ‘middle-age spread’ also takes over as more fat gets distributed around the central and upper portions of their bodies. Also some men find it hard to concentrate on work and are unable to pay much attention to relationships — personal and professional. Usually there is an accompanying decrease in libido and sexual energy as well, even though they generally try harder to keep their normal sexual rhythms going. More often than not, they mistakenly diagnose themselves as going through a depression and ignore these symptoms. Although Andropause can be part of a mid-life crisis, the latter phenomenon involves much more and merits more detailed exploration at another time.

Insidious start

So, what actually happens to men between the ages of 40 and 55? Put simply, their primary male hormone — testosterone — starts slowing down. The body progressively reduces its installed production capacity from the late twenties of the average man’s life and by the time he hits his forties and fifties, the drop in testosterone levels becomes perceptible. Sometimes, the drop tends to be sharper and therefore the symptoms may appear suddenly in some men, but by and large Andropause starts, like menopause, insidiously. After a couple of years or so, the body gets acclimatised to the new levels of testosterone and life goes on as usual, but if the testosterone levels are slow to stabilise, some men end up being at a high risk for developing two medical problems — osteoporosis and cardiovascular disease.

Osteoporosis is usually thought of as a woman’s disease since women are more prone to developing it than are men. However in the event of prolonged testosterone deficiency, men too enter the high-risk zone to develop the illness. As the name suggests, the illness is a case of ‘porous bones’ resulting from loss of bone tissue. The bones become weak and easily vulnerable to fractures. Also, the illness can progress to an extremely painful condition. In short, an extremely avoidable illness.

Low testosterone levels also increase the risk of cardiovascular disease. Although this fact is not yet as well documented as the relationship between osteoporosis and testosterone levels, all accumulating research evidence seems to point in this direction.

Of course, not all andropausal men end up with osteoporosis or cardiovascular disease, but, as I see it, the other symptoms of Andropause are hard enough to deal with and one doesn’t have wait for major illnesses to strike before taking recourse to medical treatment. Men in this age group have a hard enough time dealing with everything else on their plates and the last thing they need is a lowered sense of self worth because their sexual functioning is not as good as before. Many andropausal men also experience a lot of stress at work on account of the general loss of initiative, energy and concentration. As a result, there is the frightening prospect of losing their jobs or suffering business losses as well. And you know what this does for one’s self-esteem especially if one is in one’s early forties or thereabouts.

Treatment options

Probably the best thing about Andropause is that it is amenable to medical treatment. Hormone Replacement Therapy (HRT) is possible and the duration of treatment would really depend on testosterone levels and a few other medical factors. HRT, when administered by an experienced practitioner, despite having received bad press, is safe and can be beneficial, particularly in cases where the risk of osteoporosis or cardiovascular disease is high. All andropausal men may not need HRT, but whether or not it is advisable is best decided in consultation with an andrologist/sexual therapist/endocrinologist/psychiatrist.

What your physician would likely do is to order a couple of blood tests. Serum Free Testosterone (SFT) will tell you whether the level of testosterone in your blood is low or normal. Usually this test is done on three separate occasions before a conclusion is arrived at, since blood levels of testosterone can fluctuate a lot. Also your physician may ask for a Prostate Specific Antigen (PSA) blood test to ensure that your prostate is doing all right, otherwise HRT may not be possible. Your physician may want a few other tests like tests of bone density, before taking a final decision. If you do decide on the HRT route, you might just need to pop a couple of pills a day and get your SFT levels checked every now and again. However, be warned. Never try HRT unsupervised; you could end up with severe complications including prostate cancer if you do.

HRT is not mandatory. Andropause, like menopause, is a self-limiting condition and you could be back to normal, on an average, in a year or two. Some men have it worse than others for a variety of reasons and may have a longer andropausal duration and require the support of HRT. Some men benefit from the use of other interventions like yoga, homeopathy, acupuncture and so on.

There are, of course, those extremely fortunate men, who sail through their Andropause with enviable ease. But the rest of us, whether we like it or not, are forced to pause.