Male menopause (=Andropause)

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[edit] Male menopause (=Andropause)

Introduction:

Male menopause is a lot more subtle than menopause in women. Many men have male potency until late in life. However, there are a significant number of men who get male impotence, also termed "erectile dysfunction" (=ED). This problem usually occurs in middle aged men.

Diagnostic tests:

A significant number of these men have low testosterone levels when they are tested as well as increased levels of LH and FSH. It is generally accepted that the reason for this is that the testicles no longer produce enough testosterone. However, there might be a significant number of men who are producing less testosterone due to inhibitory mechanisms of the gonadotropin hormone production at the level of the pituitary gland.

If the man is overweight and has a history or diabetes or hypertension, there is a good chance that this man would suffer from the syndrome of insulin resistance. In this case there is an inhibitory action on the pituitary gland by interfering with cyclic AMP production, which in turn leads to lower testosterone production. As I outlined under the link above, this knowledge has some practical implications as the low testosterone in this case is only a symptom, not the cause of the erectile dysfunction. This has also some therapeutic implications as we will see below.

Symptoms:

Men with male menopause have often similar psychological symptoms that menopausal women also have such as irritability, a lack of energy, mood changes and depression. Most annoyingly though for them is that their sex life is suffering. There is a diminished sex drive, sexual interests are also diminished, erection problems are more common and erections do not last as long.

Other health problems such as cardiac problems, pulmonary problems like emphysema, hypertension and diabetes have a lot to do with erectile dysfunction.

However, all of these medical ailments are usually treated with a variety of drugs causing impotence. Such drugs as diuretics, many antidepressants, pain medications, alcohol, cocaine, anxiolytics and cimetidine (an anti-acid medication) are all known to cause erectile dysfunction. Some hormonal problems such as hypo- and hyperthyroidism as well as Cushing's syndrome are also known to cause erectile dysfunction. Diabetes and impotence are also connected.

Impotence Treatment:

It follows from what was said above that all the factors that can be identified , which have a negative bearing on erectile dysfunction, should be treated first. This includes a thorough history and physical examination by your family physician, a review of drugs, alcohol consumption and medications.

Next there should be a life style change, which includes a zone diet program (Ref.1 and 12), a regular brisk walking program and relaxation exercises including meditation and hypnosis. Often the change of all of these factors will have a beneficial effect on the hormone balance to the point where within 3 to 4 weeks a normal sexual function returns due to the returning of the normal gonadotropin function (insulin resistance is disappearing).

If all of these measures do not help alone, then an impotence pill
such as sildenafil (brandname: Viagra) and others of that type can be considered. However, there are a significant number of side effects with this medication such as headaches and clotting problems that limit the use for certain patients. Other ways to treat are testosterone replacement therapy with low doses, which can stimulate libido significantly (Ref. 13). However, like with all potent medications, there are testosterone side-effects, namely hepatic toxicity and with longterm use the risk of liver cancer. Also, blood gets thickened (secondary polycythemia), which can cause a stroke. Patients on testosterone need to be monitored for these side effects accordingly. Viagra might be useful in some patients, if cardiovascular problems allow this and erectile dysfunction is a prominent symptom. Ask your doctor about this who can explain to you side-effects in more detail.

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