Evidence builds to support notion of `male menopause'

Health problems linked to hormonal changes

`Male menopause' is gaining credibility

May 07, 2000|By Gary Dorsey | By Gary Dorsey,SUN STAFF

The once questionable notion of "male menopause" is gaining credibility among scientists and physicians as evidence mounts that hormonal changes can significantly affect the health of men as they age.

A steady accumulation of research over the past five years has linked men's natural decline in testosterone and other hormones to osteoporosis, depression, an increase in body fat, muscular degeneration, decreased libido, fatigue and changes in mental acuity.

"I think it's very significant and very important," said Adrian Dobs, an endocrinologist at the Johns Hopkins School of Medicine who studies male hormonal change. "There have been estimates that as many as 15 [percent] to 20 percent of men over 65 suffer from low testosterone levels. It's high, but it's not everyone. It's important to note that it won't take place in all men."

Recent research has been convincing enough that in March, the Journal of Urology published an appeal to physicians to recognize hormone-related changes in some men as a distinct clinical condition.

The journal reported that emotional and physical changes associated with hormonal declines in men need to be not only monitored, but also given more serious attention from a largely skeptical medical community.

"There's more data coming out all the time that the aging male is really more affected by low testosterone levels than we ever really thought," said one of the authors, Dr. Culley Carson III of the University of North Carolina. "These are general health issues, not just sexual problems."

A lack of understanding of men's hormonal changes - known as "andropause" when testosterone levels become deficient - is thought to be common among American physicians.

The problem is exacerbated by irresponsible claims by overzealous advocates about testosterone's ability to boost self-confidence, drive aggression and even make men more successful in business.

Many urologists, who treat hormone deficiencies, are skeptical and regard "male menopause" as a laughable notion.

"It's a highly under-diagnosed problem," said Phillip Ginsberg, urology department chairman at Albert Einstein Medical Center in Philadelphia. "Doctors know a lot about how to treat female hormonal changes but very few know how to recognize and treat men.

`This is embarrassing'

"I recently did grand rounds [teaching by case study] about it for the department of medicine here, and you could hear the urologists mumbling under their breaths, `This is embarrassing.' The general population is more aware than a lot of doctors."

For 68-year-old Bruce Eicher of Timonium, the lack of understanding by his family practitioner could have left him dispirited from a flagging sex drive. A few years ago, when Eicher went to his doctor complaining of a loss of libido, the doctor brushed it off as a common complaint in aging men.

"I wasn't content with that answer," Eicher said. "I don't think we should be put out to pasture that early."

A later evaluation by Dobs showed that Eicher suffered from low testosterone, apparently the result of aging. Hormone therapy returned his sexual desire within three weeks, increased his muscle mass, decreased his body fat slightly and offered him immediate protection from early onset of osteoporosis.

"I'm very happy about it," Eicher said. "It's silly for men not to talk about this. If there's a solution, you should go for it."

Skeptics argue that science has not offered enough reassurance that hormonal replacement therapy is safe and that too few large-scale studies have been conducted to verify its benefits. Some go so far as to suggest that commercial interests are merely promoting the idea to lure baby boomers into a lucrative market for anti-aging products.

`Absolute hocus-pocus'

"The idea of male menopause is absolute hocus-pocus," said John McKinlay, director of the New England Research Institute, which conducts research on men's health. "We are inappropriately extrapolating from the female experience and we'll do the same thing with men that we did 25 years ago with women - find a disease to fit the drug."

Scientists say they do not understand the cause-and-effect relationship between men's health and their hormones, but it is generally accepted that levels of male hormones - androgens - decrease by middle age.

The scientists also have discovered that hormone replacement therapy helps some men who suffer from serious androgen deficiencies rebuild bone density, increase muscle mass, drop belly fat and improve their mood.

Focus on testosterone

The focus of research has been testosterone, the most potent androgen.

Although it is known that testosterone levels peak in a man's early 20s and then decline about 1 percent a year, scientists have not decided what level marks a true deficiency or which men will be most affected because the "normal" range may be highly variable.

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