Research If you’re born a woman, you learn pretty early on that hormones are going to pay a big part in your life. It starts with puberty, carries on every month with periods, and then, when they tail off, you get hit by the menopause.
While men don’t get off scot-free – puberty plays cruel tricks on them too –the notion of a male menopause was until recently little more than an excuse for buying an unsuitable sports car or bouts of bad temper. However, new research has changed that. The ‘male menopause (or late-onset hypogonadism, to give the condition its official name) does exist, but only in two percent of older men.
A team of scientists at the University of Manchester, working with researchers at Imperial College London, University College London and other European partners studied 3,369 men aged from 40 to 79, from eight European centres. The study, published in the New England Journal of Medicine, involved measuring the men’s testosterone levels and asking them questions about their sexual, physical and psychological health.
There were 32 possible symptoms that could have been related to low levels of testosterone. However the team found that only nine of the 32 were actually associated with low testosterone. At the end of the study the researchers concluded that to establish a diagnosis of late-onset hypogonadism, the participants had to have low testosterone levels as well as all three sexual symptoms on the list. These are:
- decreased frequency of morning erection
- decreased sex drive
- erectile dysfunction (difficulty in having, or keeping, an erection).
Men who fit these criteria may also have other symptoms. These include an inability to carry out vigorous activity, such as running or lifting heavy objects, being unable to walk more than one kilometre and being unable to bend and stoop. Men with low testosterone may also experience these three psychological symptoms: loss of energy, sadness and fatigue. However the research team point out that these physical and psychological symptoms were only weakly related to low testosterone levels. And other symptoms often linked to the notion of a male menopause, such as trouble sleeping, poor concentration and anxiety, turned out not to be associated with low testosterone.
"Our findings have for the first time identified the key symptoms of late-onset hypogonadism," said Professor Fred Wu, from the University of Manchester's School of Biomedicine, who led the study. "And they suggest that testosterone treatment may only be useful in a relatively small number of cases where androgen deficiency is suspected, since many candidate symptoms of classic hypogonadism (which can occur at any age) were not associated with decreased testosterone levels in older men."
Professor Wu added: "The long list of non-specific symptoms that have a potential association with testosterone deficiency makes it difficult to establish a clear diagnosis of late-onset hypogonadism. This situation is further complicated when you consider that even the most specific sexual symptoms of androgen deficiency were relatively common among men with normal testosterone levels.
"It is therefore important to specify the presence of all three sexual symptoms of the nine testosterone-related symptoms we identified, together with low testosterone, in order to increase the probability of correctly diagnosing late-onset hypogonadism. The application of these new criteria should guard against the excessive diagnosis of hypogonadism and curb the unwise use of testosterone therapy in older men."
The results of this research should help doctors who prescribe male testosterone therapy to patients. Interestingly, since 1999 this practice has increased by 400 per cent in the United States, where drug companies are allowed to carry out direct marketing to the public, something that isn't allowed in the UK and Europe.
Here there has been a small increase in the percentage of patients prescribed male testosterone therapy, but nothing like that seen in the USA. As with many drugs, testosterone can have side effects. These include enlarging breasts, limiting sperm production or causing your testicles to shrink and possibly stimulating an existing prostate cancer. If you are concerned about your testosterone levels, and possible related symptoms, see your GP.
First published June 17, 2010.