Dear Dr. Garner,
My husband just turned 58 the other day. He was always such a calm and patient person. Now he is easily irritated, has mood swings and has become highly emotional.
If I didn’t know better, I’d think he was going through menopause. Is there such a thing? Can it be treated?
My husband is going through menopause in Maspeth

Dear Menopause,
Male menopause is a subject most doctors are not convinced exists. There is such a thing as a mid-life crisis, where men act somewhat strange, but it is not male menopause. It is related to a change in lifestyle, with the kids moving out of the house, fewer responsibilities and a realization that time is moving ahead at a fast pace. This is often a time in life when stability has been achieved and the struggles that were once a large part of life are now at an end. This new awareness that a life change has taken place can trigger a crisis. For some men, stability may signify an end to vitality or youth.

Male menopause, on the other hand, describes a drop in male hormone levels after middle age, leading to depression, anxiety and low libido. There is controversy whether it actually exists, because it is not associated with a sharp drop in hormones and the cessation of a bodily function as in the case of female menopause when women’s periods stop.

When a female goes through menopause, there is an abrupt shut off of the hormone estrogen. In men, the corresponding hormone, testosterone, which is produced by the testes, decreases with old age, but not as abruptly. The decline may not affect men at all.

An interesting study related to male hormone levels released late last year, showed an overall decrease in testosterone levels in adult men in the United States over the past 20 years. The reason for this decline is postulated to be due to increasing obesity, which causes a fall in testosterone. The second reason is an interesting one. It seems that cigarette smoking causes an increase in testosterone. As we have been successful in getting men to stop smoking, the testosterone levels have dropped as a result. I am not advocating that men start to smoke, but this is one reason there has been a 20% drop in testosterone over the past 20 years.

Low testosterone levels are associated with a host of symptoms, which are estimated to affect two to four million men in the U.S. These symptoms may also increase mortality. In a recent study, it was found that men with low testosterone have increased deaths from heart disease, diabetes, and depression.

The symptoms of male menopause include:
• Depression
• Sadness
• Irritability
• Low libido
• Erectile dysfunction
• Anxiety
• Hot flashes
• Sweating
• Memory problems
• Concentration problems

These symptoms are also caused by other conditions and are not specific to low hormone levels. When associated with low testosterone levels, male menopause should be considered.

Growing recognition of the morbidity and mortality risks associated with low testosterone levels has created an increase in use of various forms of testosterone replacement therapy. Sales of prescription testosterone in the U.S. have increased significantly in recent years. This enormous increase is not without risk.

Indiscriminate use of testosterone supplements can increase the risk of prostate cancer, bleeding disorder, strokes, and cholesterol levels. Testosterone replacement therapy should be prescribed only when men have low testosterone levels and symptoms that are definitely associated with this.

Male depression and irritability have been shown in studies to improve significantly with testosterone replacement treatment. It also improves mental function, night sweats, bone density and muscle mass, energy levels and libido.

As testosterone deficiency is normally a permanent condition, lifelong treatment is usually required. It can be prescribed as injections, implants, transdermal patches and gels. Testosterone replacement is contraindicated in men, with carcinoma of the breast or known or suspected carcinoma of the prostate.

Testosterone replacement therapy must always be administered by a responsible physician, using strict case selection and supervision. It is not to be used as a tonic for vague complaints, as it can cause serious side effects including prostate cancer. Evaluation of potential candidates for testosterone replacement therapy should include a complete medical history and hormone screening.

In summary, there is a definite decline in testosterone levels as men age. In some men, a low testosterone level is accompanied by symptoms such as mood swings and a decrease in energy, which can be classified as male menopause. It is these men who should be considered for hormone replacement therapy.

While considered safe by many physicians, let us not forget the misinformation we received regarding female hormone replacement and its safety. As a result of scientific studies recently released, most women today take hormone replacement for only a few months to help get them through difficult symptoms. There have been very few studies that examine the long-term harmful effects of testosterone replacement. It is for this reason that replacement must be limited to proven low levels and related symptoms.

I hope this has helped to clear up your question. I suggest your husband be evaluated for low testosterone level and together with his physician arrive at the right course of treatment.

Dr. Steven Garner is affiliated with New York Methodist Hospital in Park Slope and is a Fidelis Care provider. He is host of the popular “Ask the Doctor” TV program on The Prayer Channel (Ch. 97 on Time Warner, or Ch. 30 on Cablevision).