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Exploring male menopause

18 May 2022 Bonitas Medical Fund
Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund

Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund

Recently there has been increased discussions around male menopause. However, research shows that not all doctors and psychologists agree that there is a definitive male menopause or andropause.

Dr Morgan Mkhatshwa, Head of Operations at Bonitas Medical Fund, says this is because not all men experience it and, for those who do, they often don’t express their feelings as freely as women - as a result only a few men exhibit ‘midlife crisis’ symptoms.

What is ‘male menopause’?
It is the decline in the levels of the male hormone testosterone in men, just as women’s levels of estrogen begin to decrease, any time from the age of 40+. Some doctors refer to it as low testosterone.

It is normal to experience a decline in the production of the male hormone testosterone with ageing but this also occurs with conditions such as diabetes. This gradual decline of testosterone levels is called late-onset hypogonadism or age-related low testosterone. It is a more gradual than female menopause where ovulation ends and hormone production plummets during a relatively short time.

When does ‘male menopause’ start?
Andropause or male menopause can begin at about age 40 (but can start earlier) and continue into the 70s.

Why is it not talked about more?
There is not much research into the subject, probably because you don’t die from the reduction in gonadal hormones and the withdrawal of hormones is not as dramatic as in women. Together with the reduction in hormones, there are often other factors involved when men experience this. For example, work pressure, marital pressures, life management and lifestyles exacerbate the problem. Many practitioners believe that balanced, youthful levels of human hormones improve the quality of life.

What are some of the symptoms?
• Decreased mental sharpness (poor concentration, depressed mood)
• Decreased energy and strength
• Weight gain, decreased muscle and increased fat
• Depression and/or loss of eagerness and enthusiasm
• Irritability
• Sore body syndrome (feeling stiffness)
• Hot flushes or sweats
• Cold hands and feet
• Itching
• Poor sexual function
• Height loss

Dr Mkhatshwa says some men feel the pressing need to make major changes because they feel ‘life is too short’ or have a feeling of dissatisfaction with their career, marriage and health. This can lead to restlessness about changes in appearance and making out of character choices, such as having an affair or a sudden desire for excitement or thrilling experiences.

Getting help
Men cope with menopause in different ways, it depends largely on their personality. The reduction in hormones often coincides with children leaving home, friends getting sick, marriages in trouble and job horizons narrowing. Combined with physical, psychological and sexual symptoms it is critical for men to acknowledge the challenges and seek the help of their family doctor, spouse, friends and support groups.

How does one test for male menopause/andropause?
It’s best to make an appointment with your GP who will: Perform a physical exam, ask about symptoms, order tests to rule out medical problems that may be contributing to the condition and do blood tests, which may include measuring testosterone level.

Helping your body and mind cope with andropause
• Diet: A healthy diet, which includes a balance of vegetables, fruits, meats, fish and dairy products
• Fitness: Engage in regular exercise, including aerobic, muscular and flexibility exercises
• Get regular health check-ups including cardiovascular, prostate and testicular cancer
• Check hormone levels as you get older. Generally, between 40 and 55 several important hormones in a man’s body begin to decline
• Reduce stress in your life. Exercise and relaxation help to reduce stress, as does talking to your partner, friends and family about your problems
• Although sex is still important as you go through male menopause, you will start to view sex as a part of a loving relationship which includes friendship, intimacy and sharing
• Get plenty of sleep

What about Testosterone Replacement Therapy (TRT), does it work?
Medical experts are divided on this. It may improve the sexual function to some extent but there is no evidence that it improves any other symptoms.

Are there any dangers or side effects?
Men should avoid TRT if they are at high risk of prostate cancer, have severe urinary symptoms from prostate enlargement, have diagnosed heart disease, sleep apnea, a combination of risk factors for a heart attack or are prone to thrombo-embolic events.

TRT does have associated risks, including:
• Worsening sleep apnoea (a potentially serious sleep disorder in which breathing repeatedly stops and starts)
• Causing acne or other skin reactions
• Stimulating noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer
• Enlarged breasts
• Limiting sperm production or causing testicles to shrink
• Stimulating too much red blood cell production, which contributes to the increased risk of forming a blood clot
• Fluid retention, etc.

Unlike menopause in women, Dr Mkhatshwa believes more research is needed on andropause or male menopause to completely understand it and determine what can be done to assist men through this phase of their lives.

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