Health Q&As: male menopause and steroid injections for frozen shoulder

Dr David Roche / 02 September 2014

Saga Magazine's GP, Dr Roche, answers questions about the male menopause and steroid injections for frozen shoulder.

I have hot sweats, could it be the male menopause?

Question: I understand men can suffer from the andropause (male menopause). I am 70. Two years ago I fell from a ladder and broke my back (now generally OK). Since then I have suffered from hot sweats, which are just random and can be quite severe, soaking my clothes. I am awaiting an appointment with an endocrinologist (whatever that is). Do you have any thoughts or advice about my problem. Is is common, or am I peculiar?

Answer: Hot sweats can occur in a variety of conditions so the first step is ensure there are no other causes. The endocrinologist you are about to see will help to exclude these. Endocrinologists have expertise in the diseases of the endocrine glands which include the thyroid, adrenal glands, pancreas and sex organs, amongst others.

Testosterone levels can be checked on a blood test, if they are lower than the normal range then this can be described as a ‘male menopause’. Testosterone can be replaced in the body by injection or skin gel.

The controversy comes when those levels are within the normal range but are slowly declining with age, a natural occurrence.

Can this slow decline be held responsible for some of the symptoms men experience at this stage of life? Welcome to the wide variety of opinions that exist about the existence of the male menopause, which stretch from those who believe only a tiny number of men require testosterone supplements to those who believe that the majority of men would benefit.

It is a place to tread carefully as supplementing testosterone may have unforeseen hazards, for example accelerating the development of prostate cancer. The science behind the male menopause is very much in its infancy so many of the questions cannot yet be answered.

One piece of research correlated symptoms that men recorded to their testosterone levels. Only very sexual symptoms, eg poor morning erections, low sex drive and erection problems were related, while a whole raft of other symptoms eg fatigue, feelings of worthlessness, anxiety, sleep changes and poor concentration, showed no connection with testosterone levels.

My current approach would be to only consider testosterone supplementation in those with sexual symptoms who have levels below the normal range and after all other possible causes have been excluded.

Will a steroid injection work on my frozen shoulder?

Question: I have a frozen shoulder and my GP recommends a steroid injection but I'm nervous - is this safe and will it work?

Answer: Frozen shoulders can occur on their own or as an abnormal response to an injury to the shoulder. The normally elastic capsule, which surrounds the joint, becomes inflamed and stiff, restricting the joint and often being very painful.

It has a natural history of several years before it resolves and is so disabling that patients are always keen to improve it as quickly as possible.

It is safe to have a steroid injection in the shoulder and a correctly diagnosed frozen shoulder is one of the circumstances where it can be particularly effective, often combined with a course of physiotherapy to follow.

An injection can give relief from pain but it's not a cure. Pain reduction can allow the physiotherapist to improve the range of movements and the injection can be repeated if the pain or symptoms deteriorate again.

The risks of the injection are very small, aseptic technique is used to reduce the risk of introducing infection with the needle and the only other problem is the occasional person who reacts to the presence of the steroid in the joint, this is rare.

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The opinions expressed are those of the author and are not held by Saga unless specifically stated.

The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.