Experts Call Male Menopause a Myth

Not All Men Will Need Testosterone Replacement Therapy


Dec. 2, 2011 (New York City) -- It may be called "men"-opause, but it's a time of life that only belongs to women. Male menopause, well, that may be a myth, according to some experts.
While many men and men's health experts argue that male menopause (andropause) occurs when a man's supply of the male sex hormone testosterone dwindles with advancing age, there really is no such thing, says Bradley Anawalt, MD, an endocrinologist at the University of Washington in Seattle. Anawalt spoke at a meeting sponsored by the Endocrine Society in New York City.
"When we use the term menopause with women, it refers to a precipitous fall in levels of the [female sex hormone] estrogen in three to five years as their ovaries stop functioning properly," he says.
It's a different situation with men. "There is a decline on average of 1% of testosterone per year starting at age 30," he says. "It is not a seminal event and doesn't occur in all men. Some men who are very healthy and virile do maintain their testosterone levels for longer periods of time."

 

 

To Treat Low Testosterone or Not to Treat It?

This is not to say that certain men with declining levels of testosterone can't benefit from testosterone replacement therapy. Who should be treated for low testosterone, and who should not is more of an art than a science, Anawalt says.
 
"Testosterone replacement therapy is viewed as the fountain of youth in men," he says. "Testosterone is not a [cure-all] for everything for everybody. There is clearly a segment of older men who will benefit from testosterone treatment, but this is not a universal truth and not all men should be on it."
"We have to look at 50- to 60-year-old men and say, 'Do they have symptoms and signs that suggest low testosterone?' And then we need to confirm with blood tests," he says.
Symptoms of low testosterone may include:

• Low libido
• Decreased sexual desire
• Decreased rigidity of an erection
• Reduced energy
• Decreased sense of well-being
• Brittle bones
• General weakness

Part of the problem is that it can be hard to accurately measure testosterone levels in the blood, Anawalt says.
Some men may have low levels of total testosterone but normal levels of so-called free testosterone, which is the hormonally active form. "We think these men are normal," he says.

 

Testosterone Risks

Buyer beware, Anawalt says. "It's easy to get testosterone off the Internet or from people who have low standards for prescribing it. Many men are started for questionable reasons, and their dose keeps getting ratcheted up," he says.
Some doctors are also prescribing human chorionic gonadotropin (HCG) to stimulate testosterone production. HCG is sometimes used to treat women's fertility problems and is at the center of the controversial HCG diet.
"HCG should not be used for testosterone replacement," Anawalt says. "This raises a lot of red flags."
"The best thing men can do is not start testosterone therapy unless they have been fully evaluated by an endocrinologist or knowledgeable internist," he says.
Henry Anhalt, DO, an endocrinologist in Hackensack, N.J., agrees that the indiscriminate use of testosterone supplements is risky business.
"There is a role for testosterone replacement therapy in those who are evaluated by an endocrinologist and who understand the issues around lab testing," he says. "The abuse of testosterone in both older people and younger people is rampant. It could be very very dangerous.'
Risks may include:

• Shrinkage of testes
• Decrease in HDL "good" cholesterol levels
• Acne
• Prostate gland enlargement

Second Opinion

Jed Diamond, PhD, contends that male menopause isn't a myth. "In my opinion, it is very real," he says. Diamond is the director of MenAlive, a male health program in Willits, Calif. He's also the author of Male Menopause and Surviving Male Menopause.
"The term itself is not literally accurate," he says. "Men don't have a menstrual cycle so they don't stop having one. Hormonal, physical, and psychological changes do occur in men at midlife."
"Testosterone is not something we do for every man," Diamond says. "Not all men need it or would benefit from it."
Other treatments including counseling may also help men cope with the symptoms of this time of life.
SOURCES: The Endocrine Society, Science Writers Conference, New York City, Dec. 2, 2011.Jed Diamond, PhD, director, MenAlive, Willits.Bradley Anawalt, MD, endocrinologist, University of Washington, Seattle.Henry Anhalt, DO, endocrinologist, Hackensack, N.J.
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By Denise Mann
WebMD Health News
Reviewed by Laura J. Martin, MD
http://www.medicinenet.com/script/main/art.asp?articlekey=152229

18 Secrets Men Want You to Know

Was your guy raised as a traditional, stoic, man's man? If so, let's  walk you through 18 relationship secrets, gathered from psychologists who study gender roles.

1: It may be easier for your man to talk about feelings indirectly. Ask what he'd do during a romantic weekend. Or what he thought the first time he met you. His answers will reveal how he feels and bring you closer.

2. Men Say "I Love You" With Actions. Some men prefer to express their feelings through actions rather than words. Your guy may say "I love you" by fixing things around the house, tidying up the yard, or even taking out the trash -- anything that makes your world a better place.

3. Men Take Commitment Seriously. Men have a reputation for being afraid to commit. But the evidence suggests men take marriage seriously. They may take longer to commit because they want to make sure they are on board for good. In a survey of currently married men, 90% say they would marry the same woman again.

4. He Really Is Listening. When you're listening to someone talk, you probably pipe in with a "yes" or "I see" every now and then. It's your way of saying, "I'm listening." But some guys don't do this. Just because a man isn't saying anything doesn't mean he's not listening. He may prefer to listen quietly and think about what you're saying.

5. Shared Activities Form Bonds. Men strengthen their relationships primarily through shared activities more than by sharing thoughts or feelings. For many men, activities like sports and sex make them feel closer to their partner.

6. Men Need Time for Themselves. While shared activities are important, men also need time for themselves. Whether your guy enjoys golf, gardening, or working out at the gym, encourage him to pursue his hobbies, while you make time for your own. When both partners have space to nurture their individuality, they have more to give to each other."
 

7. Men Learn From Their Fathers. If you want to know how a man will act in a relationship, get to know his dad. Some say men learn about their relationship role by watching and listening to their fathers. How they are with each other and how the father relates to the mother can predict how a man will relate to his wife.

8. Men Let Go Faster Than Women. Women tend to remember negative experiences longer and may have lingering feelings of stress, anxiety, or sadness. In contrast, men are less likely to dwell on unpleasant events and tend to move on more quickly. So while you may still want to talk about last night's argument, your guy may have already forgotten about it.

9. Men Don't Pick Up on Subtle Cues. Men are more likely to miss subtle signals like tone of voice or facial expressions. And they are especially likely to miss sadness on a woman's face. If you want to make sure your guy gets the message, be direct.

10. Men Respond to AppreciationShowing appreciation for your guy can make a big difference in the way he acts. Take parenting. Studies show that fathers are more involved in care-giving when their wives value their involvement and see them as competent.
 

11. Men Think About Sex ... A LotOK, so maybe this one is no secret. The majority of men under age 60 think about sex at least once a day, compared with only a quarter of women. And that's not all. Men fantasize about sex nearly twice as often as women do, and their fantasies are much more varied. They also think more about casual sex than women do. But thinking is not the same as doing.
 

12. Men Find Sex Significant. It's a myth that most men think sex is just sex. For many, sex is a very important act between two committed people. And just like most women, men find sexual intimacy to be most satisfying in the context of a committed relationship. One reason is that long-term partners know how to please one another better than strangers do.
 

13. He Likes It When You Initiate Sex. Most guys feel as though they're the ones who always initiate sex. But they also like to be pursued and wish their partner would take the lead more often. Don't be shy about letting your guy know you're in the mood. Initiating sex some of the time may lead to a higher level of satisfaction for both of you.
 

14. Guys Aren't Always Up for Sex. Men, much to many women's surprise, aren't always in the mood for sex. Just like women, men are often stressed by the demands of work, family, and paying the bills. And stress is a big libido crusher. When a guy says, "not tonight," it doesn't mean he's lost interest in you. He just means he doesn't want to have sex right then.

15. Men Like Pleasing Their Partner. Your pleasure is important to your man. But he won't know what you want unless you tell him. Too many women feel uncomfortable talking about what they like and don't like. If you can tell him clearly in a way that doesn't bruise his ego, he'll listen. Because he knows he'll feel good if you feel good.
 

16. Guys Get Performance Anxiety. Most men get performance anxiety on occasion, especially as they age. Your guy may worry about his physique, technique, and stamina. If you can help him learn to relax and stay focused on the pleasures of the moment, sex will become less stressful.
 

17. Men May Stray When Needs Aren't Met . If a man doesn't feel loved and appreciated in his relationship, he may turn elsewhere for satisfaction. For one man, that may mean burying himself in work. Another may develop a fixation on sports or video games. And some men cheat. To avoid this, partners need to work together to meet each other's needs.  

18. He's Vested in You. Most men realize there's a lot to lose if a long-term relationship goes sour – not just each other's company, but the entire life you've built together. If you're willing to work to strengthen your marriage, chances are your man will be, too.

Reference
http://www.medicinenet.com/18_secrets_men_want_you_to_know_pictures_slideshow/article.htm