Doctors, researchers and drug companies have begun making the case that just like women, men also experience a change of life. This male menopause — "manopause," if you will — is said to stem from an age-related decline in testosterone, the hormone that plays a key role in everything from puberty to maintaining muscle strength and bone mass to sex drive.
"What we see is that for men, often beginning in their late 30s or early 40s, there is a gradual drop in testosterone of about 1 to 2 percent a year," explains Robert Brannigan, a urologist at Northwestern Memorial Hospital in Chicago who has been researching the phenomenon. "It's not as dramatic or as abrupt a change as is often the case in women, but there is this subtle shift in hormone levels that can result, over time, in a man crossing a threshold where he then has a deficit of testosterone."
This can result in a range of symptoms that "have a huge overall impact on day-to-day life," he says, including depression, irritability, low energy, decreased muscle mass, weight gain, sexual dysfunction and even the occasional hot flash or night sweats.
Brannigan estimates that at least 5 million U.S. men are affected by late-onset hypogonadism, the clinical term for the condition. "Unfortunately, the vast majority are undiagnosed."
That's partly because this newly recognized condition is hard to identify given its laundry list of possible symptoms. But research published recently in the New England Journal of Medicine definitively linked low testosterone levels to low sexual desire, and erectile dysfunction, and a poor morning erection, and concluded that these three symptoms must be present to diagnose late-onset hypogonadism. The study, which tracked 3,369 European men between the ages of 40 and 79, also showed that low testosterone was only somewhat related to such physical and psychological problems as an inability to engage in vigorous activity, sadness and fatigue.
Still, the notion of male menopause remains controversial. A recent article in the Drug and Therapeutics Bulletin that reviewed dozens of studies found that men's testosterone levels do not always drop with age, that low levels in older men do not necessarily produce any specific symptoms and that men with normal hormone levels experience many of the problems associated with low testosterone, including sexual dysfunction, diminished strength and depression.
Indeed, critics suggest that most of the symptoms that have been blamed on "low T" are normal consequences of aging.
But pharmaceutical companies are marketing low T and male menopause — and men are seeking tests and receiving testosterone prescriptions, which rocketed from 2.4 million in 2005 to nearly 3.9 million in 2009, according to the consulting firm IMS Health.
"I think the problem is that you have a captive audience," says Andrew Kramer, a University of Maryland School of Medicine urologist and surgeon. "When a commercial (for low-testosterone-related products) asks, 'Do you have lower energy? … Is your libido down? Are your erections not as good as they used to be?' every man, of course, is like, 'Yeah, that fits.' "
The fear is that this sort of hyper-awareness will lead to an overscreening of the aging male population.
Northwestern's Brannigan sees it differently: "The question is this: Do patients sit back and let these changes occur and deal with the change in how they feel and function, or do they actually pursue available treatments that in many cases can help?"
Still, he stresses that men with prostate cancer, a history of breast cancer or untreated sleep apnea and those trying to conceive a baby shouldn't use synthetic hormone.