“The Male Menopause?” Yes. It’s a thing.
Of all the male hormones – or androgens – nearly all clinicians would agree that testosterone is both the most important, and most potent. The term ‘androgen’ derives from the ancient Greek words for ‘man-maker’, and healthy levels of testosterone do indeed have the power to make a man feel strong. Conversely, a deficiency can lead to undesirable changes in emotion, sleep, sexual and general physical function.
From the age of 40, testosterone levels will gradually ebb away, although a large proportion of males may not feel any negative effects. It is important to first rule out other contributory factors, such as side-effects from medication, overuse of alcohol, depression and thyroid problems, and not forgetting sleep apnoea as an under-reported and under-diagnosed root cause.
Advances in testosterone treatment have meant that injections every 1 to 4 weeks are no longer the only option. Most gents now use skin patches, gels or tablets that dissolve on the tongue’s surface. It is important to be fully aware of both the risks and the benefits of testosterone replacement therapy (TRT) before starting. Here is a handy guide:
Pros – May include:
- Emotional wellbeing: Improvements in motivation, concentration and memory, mood stability or increase in happiness
- Sleep pattern: Reduced insomnia and daytime sleepiness
- Sexual function: Increase in desire, and number of spontaneous erections, reduction in erectile dysfunction
- Physical shape: Maintenance of bone density, muscle bulk and strength, reduction of body fat, or slowing of fat development
Cons – May include:
- Reduction in sperm production and fertility
- A modest increase in sleep apnoea (interrupted breathing during sleep) in at risk individuals
- Acne / oily skin
- Benign overgrowth of the prostate gland may occur; hence PSA monitoring along with prostate examination is always done before and during treatment. Notably, use of TRT is contraindicated in cases of prostate cancer.
- Cardiovascular risk: latest data analysis suggests that it is likely that TRT does not caused a marked increase in cardiovascular events, but patients must be aware of the current controversy surrounding this.