Dear Dr. Garner,
My husband is just not himself lately. He is tired all the time. He stays in the house when he is not at work. At bedtime, without going into details, things are not right either.
He is 62 years old and was in good health until about three months ago.
I saw a TV program that talked about male menopause. Do you think he might have it?
I hope you can provide some good news, as it is really taking a toll on our lives.
Worried about Husband in Williamsburg
 
Dear Worried,
Before considering a diagnosis of male menopause, other serious conditions must be excluded as a possible cause of your husband’s problem. For example, diabetes and depression can present with all the symptoms you have mentioned.

A complete physical exam and mental exam should be performed by your family doctor.

If this exam and lab tests are normal, then the possibility of male menopause should definitely be considered.  Male menopause describes an emotional and physical change that many men experience as they age. Symptoms such as low sex drive, low energy level and loss of strength and muscle are usually related to aging. It is now known that a loss of hormones, specifically testosterone in men, may be the direct cause of these symptoms.

Unlike female menopause, which has a rather sudden onset, the male menopause is a gradual process. When a man reaches his 30s, there is a slight drop in the male hormone known as testosterone, each year.

At least 30% of men in their 50s have low testosterone levels, and the number increases in the 60-and-older category. Men in their 80s have up to a 90% chance of having decreased testosterone (male menopause).
 
There are specific symptoms of male menopause which include the following:

• Low sex drive

• Lack of energy

• Depression

• Irritability and mood swings

• Impotence

• Loss of strength or muscle mass

• Increased body fat

• Hot flashes
 
Having two or more of the symptoms above should lead one to be evaluated for male menopause.

Your doctor will ask questions about your overall condition to determine if your

symptoms match those of people with low testosterone. Then a blood test is performed to check the level of testosterone in the blood, known as “free testosterone” level. (Note: many men who are tested for testosterone levels have the wrong test. It is critical that “free testosterone” be measured.)

We are only now learning about testosterone and its effects during aging. Patients must see a physician who is experienced in treating this condition.

There is no magic level for the amount of testosterone needed to carry on normal activities for men as they age. The patient and doctor must work closely together to evaluate a patient’s condition relative to testosterone level.

If testosterone is found to be low, then your doctor will consider replacing it with either pills, shots or cream. 

Testosterone should not be given if a patient has prostate cancer or severe heart disease, or other conditions which your doctor will discuss with you.

Studies regarding the effectiveness of testosterone replacement for male menopause are being evaluated. There is evidence that there can be marked improvement in sexual function, mood, body strength, bone density and the cardiovascular system.

Testosterone treatment is not totally benign and the doctor must follow a patient very carefully. Patients must have lab tests to evaluate for liver function, and prostate cancer checks periodically.

Lifestyle can also be very important in the treatment of male menopause, including a low-fat diet, exercise and stress reduction.

Many patients mistake male menopause for a midlife crisis. Men experiencing low testosterone often complain of mood swings and anger. They are frustrated because they cannot do the things they used to. They may start to fight with their spouses. They may have difficulty at work. Fortunately, male menopause can be treated, but many patients and even doctors often overlook the diagnosis.

I suggest that you and your husband visit your family doctor and discuss the symptoms your husband is experiencing.  In addition, counseling might be beneficial for you and your husband, as I am sure there is frustration on both your parts, regarding changes in the marriage and your husband’s behavior.

Please make sure to send me a follow-up letter regarding your progress. If you require a referral to a physician who specializes in this area, please feel free to contact me.

I want to thank all our readers for their continued interest in this column. Unfortunately, I cannot answer all questions sent, but will continue to do my best in dealing with the large volume of mail received.

It is a momentous week, as we celebrate the 100th anniversary of The Tablet. It is an honor to write for this great journal, and I am sure that we all look forward to the next successful 100 years.  See you at the Centennial Dinner!
Until next week, be well.

Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also is the host of “Ask the Doctor,” the popular cable TV show seen weekly on The Prayer Channel.