When he turned 35, Michael Donnelly plunged into a dark depression which left his family and friends confused and concerned about his negative attitude towards life, love and, most worryingly, himself.
“I suddenly realised that I had wasted – or perceived that I’d wasted – a large portion of my life, and had nothing to show for it,” said the East London sales manager.
“I had a feeling of self-worthlessness and that ‘lost’ feeling where you have this idea in your head that whatever you do, or wherever you go, you just don’t belong anywhere.”
Now single and 37, Michael sought counselling from a psychologist. “I had heard of male menopause, but always felt that it was more psychosomatic than the female version, which is more physiological, in terms of cessation of menstruation and hormonal changes, etc.
“On the whole, I think that men in general like to feel like men – whether it be about rugby, soccer, cars, trucks or action. When the body can no longer physically perform as it once did, this affects the mind too.
“Some of us are more prone to dwell on that, causing a mental inability to accept these physical changes. But I’ve honestly never met a man who has openly admitted to the physical changes which do and can occur, such as erectile dysfunction.”
Is it real?
We’re all familiar with the stereotype of the man who reaches a certain age and trades his wife in for a younger model, or throws in the towel at work and goes off to travel the world.
The term ‘mid-life crisis’ conjures up images of a dissatisfied, middle-aged man who suddenly goes through a series of apparently inexplicable and, sometimes, violent changes of behaviour.
But, these days, doctors and psychologists know that it is well proven that male menopause – or testosterone deficiency syndrome – is a medical condition with a wide range of symptoms. These include irritability, loss of libido, weight gain and lethargy.
Some experts argue that men are at risk of suffering the symptoms of mid-life crisis from as early as 30, although extensive clinical trials have shown that on average, from the age of 35, testosterone levels start to decline. A few psychologists argue that almost all men go through a mid-life crisis to some degree – they all have to deal with what is a time of transition and adjust to a new perspective on life, though,as with women, some men pass through this phase with no apparent difficulties.
Doctors and researchers Sindeep Bhana and Pradaruth Ramlachan are leading experts in men’s health. They argue that the condition is real, serious and can be treated – if only we recognise and give it the respect it deserves.
Bhana is an endocrinologist and award winning educationist, while Ramlachan has an MA degree in health science from the University of Sydney and lectures on various subjects related to health and medicine.
“Testosterone Deficiency Syndrome (TDS) or ‘male menopause’ is real. The onset of female menopause is an event, while male menopause is a journey, as there is no cessation of ovulation and menses in men,” explains Ramlachan.
“The ‘calm before the storm’ philosophy is ideally descriptive of the calamity that can follow unrecognised male menopause.”
What is the difference between male and female menopause? “In women, this time is easily defined by the cessation of the menstrual period for at least a year and can further be confirmed by decreased hormonal levels.
“Men, though, are generally more reluctant to present for treatment, leading to underdiagnosis and lack of research. TDS or male menopause is also more difficult to define, making it a harder concept for people to accept. The male ego is less reluctant to accept ‘menopause’ as compared to the female.”
Mind over matter?
“In terms of psychological causes, in a society which puts a particularly high value on youth, and sidelines older people, it’s difficult for many people to move smoothly into their middle years,” says Bhana.
“Men reaching mid-life may feel a loss of masculinity and confusion about their future role. Divorce, insecurity at work and the changing role of men add to the uncertainty many feel during this time of transition. Many men find unsettling the changes in sexual function which come with getting older. Suddenly, you can’t do it three times a night any more. It’s harder to get an erection.”
The very phrase ‘male menopause’ is also misleading, since the term menopause actually refers to the end of menstruation. Alternative, more appropriate names might be ‘andropause’ ‘viropause’ or even ‘endopause’, though testosterone deficiency syndrome (TDS) has become the more popular term nowadays.
The loss of libido may be linked to a decreasing level – and effect – of testosterone, the hormone responsible for secondary sexual characteristics such as muscle strength and facial hair, as well as sexual drive and hormone production. Testosterone levels gradually decrease from the late twenties, and by the time a man reaches 80, they’ll be at pre-puberty levels.
“However, unlike women, there is no sudden, measurable drop in testosterone in men in middle age, and often the testosterone levels in men complaining of andropausal symptoms can still be measured as normal,” explains Bhana.
What does appear to happen is that a carrier protein called sex hormone binding globulin (SHGB) increases in mid-life men. This increase may undermine the body’s ability to make use of its own testosterone. In addition, the cells in the body also tend to thicken with age, so they are less able to absorb testosterone.
‘The Change’ and You
If your partner is starting to exhibit worrying symptoms, you’re probably not prepared to deal with it.
Women in the firing line of male menopause may be negatively affected by the sudden change in a partner’s moods, especially the irritability which can lead to unnecessary fights, explain men’s health experts Sindeep Bhana and Pradaruth Ramlachan.
“His lack of, or decreased interest in, the bedroom, together with decreased moods, can often initiate suspicions of infidelity. Forgetfulness can also lead him to become more irresponsible with regard to household duties. The children may find it difficult to understand the change in their dad’s behaviour and may not be able to identify with him any more.
“This can be particularly difficult if they are teenagers. For the man himself, he may feel that he is losing his manhood and may start looking for other ways in which to validate it, for example, buying new sports cars, spending more time with ‘the boys’ or even resorting to having affairs.”
What is the best way to handle a menopausal man? Firstly, get him to see a doctor for treatment – both for lack of testosterone (via a three-monthly testosterone injection) and for his erectile dysfunction, via treatment called PDE5, Viagra, Levitra or Cialis. Most men, say Bhana and Ramlachan, do well on dual treatment.
“It’s important that you understand your partner and are quick to pick up on subtle changes in mood and behaviour. Discuss his symptoms with him, but don’t be upset if he can’t explain it – usually, they are as confused as you are.
“Going through menopause does not give him an excuse for being unkind, abusive, irresponsible or unfaithful! So, if his behaviour upsets you, let him know it.”
Bhana and Ramlachan caution women not to attribute all symptoms to this condition, as with age comes the increased risk of other medical problems such as cardiovascular and endocrine issues and also diabetes mellitus. These need to be diagnosed and managed, so a thorough medicine examination is vital for screening of these symptoms, which can also mask male menopause.
The way forward
Male menopause can be treated – if only men would agree to treatment and their doctors understand the condition.
Many symptoms linked to mid-life crisis need to be checked out for underlying physical causes. Erectile dysfunction, for example, can be caused by low testosterone levels, depression, diabetes or even heart disease.
Advocates of the existence of male menopause believe that testosterone replacement therapy (TRT) is the answer. The new type of testosterone – administered via a three-monthly injection – is far better than those used in the past, since the latter couldn’t ‘smooth out’ the peaks and troughs associated with treatment, resulting in side effects and/or lack of efficacy.
“In a male with TDS, the lack of testosterone is supplemented to normal levels and in this way, the signs and symptoms of TDS are addressed,” says Bhana.
The benefits of testosterone are evident only if the hormone treatment is administered responsibly. You may have heard about a link between testosterone and prostate cancer, but Ramlachan explains that testosterone does not cause this disease; it can only’feed’ an existing prostate cancer. That is why having the prostate checked before embarking on treatment is very important.
Men over 40 are at risk for prostate cancer and should, as a matter of routine, have an annual digital rectal exam. Regular monitoring of the prostate and blood count, among other routine tests, is very important in follow-up visits.
• Have a healthy lifestyle
A healthy, well-balanced lifestyle is also very important and can significantly reduce severity of symptoms. Exercise for at least 40 to 60 minutes three times per week and aim to keep the body in good shape. A body mass index (BMI) of less than or equal to 25 is advisable, as is increasing green vegetable and fruit intake.
Remember that no matter how odd he seems, this is a normal situation and with the right treatment your relationship will survive.
The ‘change’
The ‘change’ affected my whole career, says Hollywood actor
Movie star Mel Gibson says that the male menopause altered his entire acting style and approach to film-making.
The award-winning actor, who brought fame to Scotland’s William Wallace with his epic Braveheart, says that his career does not have the same meaning for him as it did in the past.
Interviewed by The Scotsman , Gibson said that while he’d continue to give his best on a job, his career had slowed down and that he’d started to “drop back” a bit. Gibson cited the male menopause as the reason for this shift in attitude.
Did you know?
A large stomach is a warning to men that their testosterone levels are low. A large waist circumference also further aggravates the issue of testosterone deficiency syndrome as it causes a vicious cycle – fat accumulation around the waist causes low testosterone and low testosterone aggravates and increases fat accumulation around the waist.
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Ageless Ageing
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