Male menopause is fraught with secrecy, shame, and denial because it strikes at the core of what it is to
be a man
GAIL SHEEHY
author,
Menopause:The Silent Passage

The woman needs to convince her man that sexual change is not the same as sexual dysfunction or impotence. The man has to confide in his woman.

Men who are prepared will be more productive. The ones who aren't are those who haven't figured out that there is more to life than sex.

At 40, men get naughty. They can also get male menopause, a state in which men experience hormonal, psychological and chemical changes. Raj Rangarajan gets to the bottom of man's most secretive rite of passage.

Take this reality check. do you suffer from the following symptoms--irritability and indecisiveness; unexplainable anxiety and fear; loss of self confidence, or depression? Are you feeling a loss of purpose or direction in life, lonely, unattractive and unloved?

The bad news is that you are experiencing male menopause. The good news, if it can be termed that, is that you are one of approximately 408 million men between the ages of 40 and 45 who are going through what doctors call the male menopause passage. It's an age when men experience hormonal, physiological and chemical changes which, like the better-known and better-researched female version, can bring about profound psychological impact. It can, however, strike as early as age 35 and linger till the 70th birthday. In Europe, they call it andropause, in Britain it's known as viropause. But whatever its Greek origins or the difference in medical terminology, it is serious, spreading rapidly under modern-day pressures, and can break you--or make you.

The onset of male menopause signals the end of the first part of a man's life and prepares him for the second half. Some can mistake it for a mid-life crisis, but owing to lack of research on the subject--unlike female menopause--it is shrouded in mystery and secrecy. What is known is that it can cause serious and permanent psychological problems. It can also be the most passionate, powerful and productive time in a man's life.

Jed Diamond, author of a recent book on the subject (Male Menopause; Publishers: Sourcebooks, USA), says that it has been discussed for more than 40 years, but is only now coming out of the closet, as it were. Says Marc Blackman, M.D., chief of endocrinology and metabolism at Johns Hopkins Bayview Medical Center: ``The male menopause is a real phenomenon and it does similar things to men as menopause does to women, although less commonly and to a lesser extent.'' While women's menopause is sudden, lasting perhaps four years, male menopause stretches over a 15-year period and quite often men are not even aware of their condition or reasons for their behaviour. Aubrey M. Hill, M.D., author of a 1993 book Viropause/Andropause says: ``My experience in studying changes men go through in mid-life has now convinced me that most men undergo what could be called male menopause and that many men suffer acutely and needlessly.''

The Key is How You Handle the Mid-life Shift

Life changes associated with male menopause can be debilitating, even fatal, for one or more reasons--stress or failure in business, rejections at the workplace, earning potential fading with time, perhaps the kids are getting married and leaving home, or perhaps friends of the same age and lifestyles falling ill or dying. It could be that parents are dying, or the wife is getting bolder and more articulate, or the marriage is breaking up. The key is how you handle such changes. Diamond feels that some men are likely to go through menopause in a more difficult manner (see Interview).

Gail Sheehy, who wrote the best-seller Menopause: The Silent Passage, says in her 1993 Vanity Fair article: ``If menopause is the silent passage, `male menopause' is the unspeakable passage. It is fraught with secrecy, shame and denial. It is much more fundamental than the ending of the fertile period of a woman's life, because it strikes at the core of what it is to be a man.'' It is not clear which comes first--the feeling of being involuntarily impotent on a certain occasion or the onset of male menopause--both these feelings being intimately connected. Doctors define impotence as the persistent ability to attain and maintain an erection adequate to permit satisfactory sexual performance. Herbert Kupperman, M.D., associate professor of medicine at New York University Medical Center, who has studied male climacteric for two decades, says some of the symptoms could be a loss of potency, which can be either premature ejaculation or inability to have an erection. Also, hot flashes similar to but generally less severe than those associated with menopausal women, or a tendency to be nervous, indecisive and prone to angry outbursts are indicators. Emotionally, like their female counterparts, men can have catastrophic repercussions like severe depression or thoughts of suicide. Men are less equipped to deal with these extremes than women, according to Dr Theresa L. Crenshaw.

An expert on male and female sexuality, Crenshaw, author of several books and articles, clarifies the meaning of hormonal changes that men undergo: ``Men experience a `lite' (meaning `light') version of menopause--physically, that is--called viropause. Their hormones and neuropeptides diminish, albeit less abruptly. Their bodies sag and change shape. Characteristic medical conditions like an enlarged prostate develop. Sexual functioning is often compromised by hormonal imbalance, disease, medications, mind or mood....''

Testosterone is largely responsible for the development of most of the male secondary sex characteristics that emerge during puberty--the deepening voice, the ability to ejaculate semen, the hairy chin, the bulging muscles, not to undermine the male lust for dominance and social status. However, declining testosterone levels do not necessarily mean reproductive meltdown or a sluggish libido. Diamond believes that: ``In the first half of a man's life there is a high level of genital-sexuality. But in the second half, you also have a deepened and broader sexuality which is a more sensuous, more intimate relationship.'' S. Mitchell Harman, M.D., Ph.D. of National Institutes of Health, who is researching the subject, says: ``If you ask an endocrinologist whether there is such a thing as male menopause, the answer will be yes and no. `No' because a sudden drop in [hormone] levels doesn't typically happen in men. `Yes' because there is a modest downward trend in total testosterone, and a slightly more prominent decline in available testosterone.'' Ageing is stressful for men and the mental and physical ramifications of an ageing man, in a cultural context, tend to be demeaning, if not depressing.

Adds Dr Richard Spark, endocrinologist at Harvard Medical School: ``Of all the immediate causes of impotency, the most common is restriction of the blood supply to the penis, often due to the narrowing of arteries, cardiac problems, smoking and drug and alcohol use. The combined effect of vascular, neurological, and hormonal systems all slowing down produces a slower sexual response.'' Opinion is divided on the subject of supplementing testosterone for listless men suffering from faltering potency or some form of the male menopause syndrome. Editors of a popular male fitness magazine recently concluded that: ``While a tired male in that critical age may feel flabby, brittle of bone, frail of muscle, besieged by frayed nerves and a flagging libido, it is not necessarily true that testosterone replacement will help.'' Some American specialists recommend testosterone treatment in individual cases, but it is not being prescribed as a ``quick fix'' to feel young again. Dr Joe Pollack, director of Men's Clinic in Sydney and Melbourne in Australia, cautions that while only 5 per cent of men experience a testosterone drop, the hormone could actually fuel growth of existing prostate tumours. Adds Dr Joyce Tenover, M.D., Ph.D., geriatrician at Emory University in Atlanta, Georgia: ``Check if there could be any other reasons for the symptoms before prescribing hormone replacement therapy.'' This therapy is mired in controversy among various practitioners of the health spectrum. Discussing options with one's personal physician is vital.

While a lot of symptoms seem to be very depressingly negative portraying a rather hopeless situation for males, the fact that male menopause has been understood and can be cured with appropriate, timely remedial action should warm the cockles of the male heart. Kenneth Goldberg, M.D., founder and director of Male Health Center in Dallas, Texas, says: ``We need to deal with the whole man--his diet, his exercise habits, his other physiological problems, his relationship with his partner, his ability to communicate and sometimes, his hormone levels.''

Machismo aside, to first accept that changes do take place in the male mind and body, is the beginning of wisdom, say experts dealing in male problems and inadequacies. As men age, concerns of the prostate, the penis and testosterone, sometimes called the `go-getter' hormone, attract attention. Many men are not conscious that each of them has a prostate gland that has to be pampered and protected. This gland, whose secretions lubricate the lining of the urethra and condition the environment for sperm, surrounds the urethra just below the bladder in a strategic position. Says Andrew Weil, M.D., ``Medical evidence reveals that younger men often suffer from inflammations and infections of this gland; those in middle age develop urinary difficulties due to enlarged prostates; and the elderly are at risk for prostate cancer.''

To prevent prostate problems, Dr Weil suggests drinking lots of water, eating plenty of soy foods and tomatoes. The phytoestrogens in soy block the negative effects of testosterone on the prostate. A Harvard School of Public Health study concluded that eating tomatoes or tomato sauce four times a week reduced a risk of prostate cancer by 50 per cent. Adds Patrick Walsh, M.D., urologist-in-chief at Johns Hopkins Medical Center: ``After age 50, and for the rest of their lives, men need a yearly prostate check-up.''

What Can a Woman Do to Help Her Man?

Several things. If you are a woman, you may ask `why' and follow up with a `how'. Most women of age are now conscious that it is their lot to undergo the middle-age passage when it comes due. Slowly, information and literature have been emanating showing that men too are afflicted by what's now recognised as male menopause, just as women are. The difference is that in men it's a continued process starting at perhaps 40 and continuing till 55 or even 70. In women, it normally lasts for four years in the mid-40s. The woman has to understand that male menopause is more than a mid-life crisis, involving real hormonal and physiological changes in her man's body. Physical changes interact with personal, family and career goals. The woman would have to encourage the man to share his feelings even when his feelings make him uncomfortable. It is perhaps important that the woman also share her problems and reactions to her menopause, so that there is mutual understanding and compassion toward each other's conditions and pathologies. Indeed, at this point, both man and woman are friends in distress.

The man sometimes feels a loss of power or purpose, occasionally even passionless and inadequate. He may feel it's the beginning of the end for him. The woman has to let him know that it's a passing phase and that soon he will be stronger and more mature with the experience. Since the most significant change for a man involves his sexuality and perhaps a fear of losing his manhood, the onus of standing by him and ridding him of his fears and desires on and off the marital bed is that of the spouse. The woman needs to convince her man that sexual change is not the same as sexual dysfunction or impotence. If a problem is suspected, try to get help together. The man has to take his woman into confidence. For, without communication, both will be miserable. While there are differences between male menopause and female menopause, there are similarities like hormonal changes, mood swings, unexpected changes in body temperature, unexplainable anxiety and occasional intemperate language caused by irritability.

It is also advisable for a man to draw support from other men so that he knows he is not alone, since all men go through these changes. Society has conditioned men to constantly act macho without being necessarily sensitive to their body's needs. Contemporary behaviour and fictional and non-fictional literature have continued to give the woman less credit than she deserves. While this mental mindset has changed immensely all over the world, generational reactions and impulses need to be addressed by men with open minds.

In this scenario, sometimes a woman too tends to take the easy way out by being constantly subservient to her man's decisions. Women tend to be biologically closer to their bodies and spirit and are in a strong position to provide another healthier point of view. When it comes to taking care of their health, men tend to get lost. It's time men start listening more closely to their bodies and their women. In the interest of spousal harmony and self-interest during these menopause years, it probably behoves the man to listen to his woman. If it's not the wife, sometimes, it is the elder in the family or the extended family patriarch who seems to know best.

Interestingly, according to Diamond, there is a hormonal basis for the mid-life gender crossover between male menopause and female menopause. As estrogen levels drop for women, the testosterone/estrogen ratio increases. On the other hand, as testosterone levels drop for men, estrogen/testosterone ratio increases. As a result, men become gentler and more introspective, while women become more testy and outgoing. Dr William Regelson, M.D., author of the book The Super-Hormone Promise: Nature's Antidote to Aging and professor of medicine at the Medical College of Medicine, Virginia adds: ``Older men produce more estrogen and have higher levels of estrogen in their brains than post-menopausal women do.'' This increase in men going through the menopause passage perhaps explains the reason why men like to be held and their greater interest in expanding their sexuality to include more time for non-genital play and intimacy.

Dr Samuel Yen, reproductive endocrinologist who studied DHEA at the University of California, says it is a drug that may help people age more gracefully. Reportedly, men and women on DHEA experienced increased energy, slept better, could handle stress, and the study participants even reported no negative side-effects. Melatonin is another hormone touted as nature's age-reversing, disease-fighting, sex-enhancing product that is supposed to help the ageing male and female.

Without a strong sense of purpose for their second half of life, men need sufficient motivation to hang around in spite of physical and psychological adversities. Diamond, a strong proponent of alternative healing methods, where the spirit is emphasised as much as the physiology of healing, recommends that men eat right, exercise regularly and take things easy, with a philosophical bent of mind. He believes male menopause is a wake-up call, telling men to prepare themselves to move on to another stage of life. The ones who are better prepared for this shift in gears will benefit and become more productive. The ones who aren't are usually the ones who haven't figured out that there's more to life than sex.

"It's a wake-up call"

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