"The jury's still out," says Harvey Sternbach, M.D., a clinical professor of psychiatry at UCLA's Neuropsychiatric Institute in Los Angeles.Sternbach
is updating the review of all available studies on male menopause that he
originally published in 1998.
"There probably is a syndrome of testosterone deficiency in aging men, and that testosterone deficiency is manifested by a diminished sexual drive, difficulty in getting or maintaining an erection, lack of energy, even irritability and grumpiness," Sternbach
"There are a lot of things that can lower testosterone levels aside from aging," Sternbach
explains."You can lower it from drug and alcohol abuse or from stress or medications.Depression lowers testosterone, as does obesity.So the timetable for lower levels of the hormone can be variable in men.What we do know is that every woman will go through menopause and not all men will go through what's called andropause, and we just don't know why."
One of the reasons scientists cannot make up their minds about male menopause is "there's no agreed-upon definition of the cut-off point for low testosterone," Sternbach
explains."See, there are different types of testosterone you can measure.So you really don't know what level the person started from, and you really don't know how much has been lost."Testosterone is present in the circulation both in protein-bound forms and in non-protein-bound formats.
Not all men lose testosterone, Sternbach
"Ah, yes, the depression side of the issue," Sternbach
says.Don't blame it all on testosterone."Part of the issue is that our society is so youth-oriented, and so, men at about the age of 45 or 50 have lots to face - probably changes in career, changes in family dynamics, the socio-cultural aspect of having a wife or partner who's midway through menopause, and what you get is men reacting.A lot of those actions are actually symptoms of depression, not testosterone levels."So if women can get hormone replacement therapy (HRT) to ease the burden of menopause, will shots of testosterone make turning 50 easier for men?
"That's problematic for men," Sternbach
says."Prostate cancer is the major concern."Testosterone does not produce or create prostate cancer.However if prostate cancer is present, testosterone can cause it to grow."Then you have to make sure that the patient doesn't have sleep apnea because testosterone can worsen sleep apnea," Sternbach
And if that's not bad enough, "in some men, believe it or not, testosterone can cause breast enlargement."Testosterone is converted in the body to the female hormone estrogen, Sternbach
agrees that male aging, male sexual dysfunction and the role of testosterone are an "increasingly big field of study."
So what should men do?
"Well first of all, make sure you're not suffering from depression," Sternbach
As a physician, "you can't just get a lab test, and treat a number," Sternbach
says."You have to treat the whole person."
Taking the testSternbach
says the St. Louis ADAM (Androgen Deficiency in the Aging Male) questionnaire is legitimate and may help men sort out the emotional from the chemical.