Andropause
(Male Menopause - Part 1)

"Age is a question of mind over matter. If you don't mind, it doesn't matter."
-- Satchel Paige

The changes came so gradually they were almost imperceptible. For most of his life he had been outgoing, happy and positive, bursting with energy and vitality and excited about life. Then one day a close friend asked him what was going on. At first he denied that anything was wrong. Then he tried to blame external circumstances for what was happening. But when he finally and honestly faced it, he had to admit that his drive, strength, energy and enthusiasm for life and love were just not what they used to be. He thought that he had many blessings in this lifetime, yet for no obvious reason, a pervading mental and physical tiredness, perhaps even depression, had descended upon him. His body had new aches and pains it had never had before. He had become moody and irritable. He had sleep problems for the first time. At home, family relations had become increasingly stressed and his social life was zilch. Loss of libido and intermittent failure to achieve an erection deepened his distress.

Sound familiar? Perhaps this describes that is happening to you or someone you know. With the baby boomers well-ensconced in their 50's, biochemical and physiological changes have fostered changes in their experience and expression of life. When talking about the hormonal changes associated with aging, what we most often hear about is menopause and hormone replacement therapy. What we don't hear about is the hormonal changes men go through.

The media and medical silence about men's hormonal changes is due in part to our male conditioning -- real men don't cry or whine and we are supposed to be strong and push through challenges with stoic self-sufficiency. We rarely seek help for our medical problems. We define ourselves through our force, power and will. Perhaps another reason we hear so little about male menopause is because we are embarrassed and our egos tell us we are less masculine if we own up to having decreased libido.

The physiological aspects of male aging are presented in the myth of Tithonus, the lover of Aurora, goddess of dawn. Aurora loved Tithonus so much that she asked her father, Zeus, to grant him eternal life. Unfortunately she forgot to request eternal youth for her lover, who began to experience the failure of his libido at about age 50. At age 60 to 70 he was somewhat impotent. By the time he was 80 years old, Tithonus had lost much of his muscle strength, and by the time he turned 90, he walked around stooped, because his bone density was disappearing.

By the time he was 100 years old, he had developed some age-related senility, which was shown in the myth by the fact that he babbled incessantly. At this stage, love's sweet bloom had wilted, and Aurora just wanted to be rid of him. Alas, Tithonus was immortal. Since she could not make him disappear, Aurora changed him into a cicada instead. Thus, the chirping of a cicada is actually the incessant babbling of a senile old man.

The changes depicted in the myth of Tithonus are associated with age-related declining male hormone production, or what has become known as andropause.

Andropause, or male menopause, occurs as a result of biochemical and accompanying physiological changes. Complex hormone (primarily testosterone) production levels drop as men age. Testosterone permeates every aspect of the male body, every nerve, every muscle fiber, every brain cell. It is responsible for the development of the male body from the androgynous embryo, which would otherwise develop into the female form. If the testosterone receptors in the fetus are not working or are insensitive to the hormone, the development of the normal features of the male body will be incomplete or abnormal.

If testosterone doesn't make its reappearance at the time of puberty, the male body will not develop secondary sexual characteristics such as a thicker musculature, facial and body hair, a deeper voice, and the male drive to procreate. Without testosterone, he will lack drive and ambition and take fewer risks.

By the time men reach their mid-50's, andropause is already in full swing. Unlike women, men do not have a clear-cut signpost such as the cessation of menstruation to mark this transition. Menopause generally occurs in women during their mid-forties to mid-fifties. Men's transition may be much more gradual and occur over 10 to 15 years. Attitude, psychological stress, alcohol, injuries or surgery, medications, obesity and infections can contribute to its onset and development.

Other things are synchronistically happening in the 50+ year-old male's world as the hormones are changing. The children are leaving, parents are dying, job horizons are narrowing and friends are having heart attacks or dealing with cancer. For the first time, a sense of mortality is entering uninvited into consciousness. Many men begin to question their values, accomplishments and direction in life. Add these external and psychological transitions to the hormone-induced internal changes and many men find themselves in a blind alley. They lack the coping and adaptation skills they need to go to the next level and there are few places to turn for help. Research is skimpy and there is a scarcity of professionals attuned to dealing with the challenges men face in their 50's. Furthermore, although andropause is recognized as a medical condition in Europe and Canada, many American physicians, mostly men, regard it as just a "mid-life crisis," and in spite of current research, don't believe andropause exists.

Are you experiencing andropause?

Although a decline in testosterone levels will occur in virtually all men as we age, there is no way of predicting who will experience andropausal symptoms of sufficient severity to seek medical help. It is also not predictable at what age symptoms will occur in a particular individual. Each man's symptoms may be also different.

If you are a male in your mid-40's or older and are concerned that you may be experiencing andropause, take this simple, yes/no test:

If you answered "yes" to question 1 or 7 and "yes" to four or more other questions, you may be experiencing symptoms of andropause. If you have a primary care physician who is in tune with men's hormonal changes, this may be a time to turn to him/her for help.

In next month's Healing Island column I will discuss some of the possibilities for treating andropause.