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Sravanthi Challapalli

Menopause affects men in almost the same ways it affects women. Worse, it's not easily detected... or suspected.

His wife was certain he was having an affair. He protested his innocence loudly, but she said that the decibel level wouldn't convince her. There were other signs, she told the doctor: He was irritable all the time, didn't pay attention to her any more, had trouble falling asleep and when he was not snapping at everyone at home, was listless and lethargic. The guilt of the extramarital affair was doing him in, she said. But questioning the patient in private revealed to the doctor that all his symptoms were typical of male menopause, and that sex, extramarital or otherwise, was the last thing on his mind.

Chennai-based sexologist Dr D. Narayana Reddy, who has just set up an andropause clinic at the Apollo Hospitals, says male menopause is only now being recognised as a genuine condition among the medical fraternity. In the early and middle years of the previous century, men usually did not live to the age where menopause set in, so "the tendency was to deny its existence," and give only symptomatic treatment. It was first recognised in 1939 as the `male climacteric', and later went through phases of being called viropause and penopause and in the 1990s, was labelled as `androgen deficiency in the ageing male,' also known as andropause or hypogonadism. Androgens are hormones such as testosterone or androsterone that control the development and maintenance of masculine characteristics including the male genitalia, growth of a moustache and beard, deepening of the voice, the muscular structure and a certain amount of aggression. Menopause is likely to set in at age 50 or above, but it's "very dicey", says Dr Reddy. It could start at 45, too. It affects men in almost the same ways as menopause affects women — irritability, hot flashes, loss of memory, panic attacks, night sweats, worry about relatively insignificant things, palpitations, disinterest in sex or sexual problems, depression, loss of muscle mass and lethargy. Men are also prone to formication (not fornication, says Dr Reddy, with a twinkle in his eye, explaining that it's a term to describe the sensation of ants crawling on the skin).

A significant difference between menopause in men and women is that while the cessation of menstruation clearly marks menopause in women, in men, it's a slower process. The lack of a clear indicator, and scepticism about its existence, made its diagnosis difficult in earlier times. Also, it came to light only in cases where men sought assistance for sexual problems; but it is far larger a phenomenon and widespread, says Dr Reddy.

Dr Reddy runs the Dega Institute in Chennai, and has been involved with andropause research for over a decade now. The number of ageing people in India is on the rise and will continue to rise. Quoting World Health Organisation statistics that peg male life expectancy at 87 years by 2015 and its forecast that, by 2025, 50 per cent of the world's population aged 65-plus will be in India and China, the doctor says it is high time people addressed male menopause. In professional life, men are generally at the mid-management level in their mid-40s, so menopause can severely affect their productivity as they cannot concentrate on work and have less drive, he explains. Hormone replacement therapy (HRT) is necessary to address these symptoms, which make it difficult for him to be useful to himself, his family and society.

Diagnosing andropause involves patients completing a questionnaire that is ranked on four domains: physical, psychological, sexual and vasomotor (to do with muscular co-ordination and the heart). Then hormone levels are estimated through a blood test to clinch the diagnosis. HRT for men involves taking testosterone supplements. There is no risk if there is a deficiency and no contra-indications. The side effects are an initial weight gain of 5 kg (which drops in 2-3 months as the body adjusts to the hormones), accumulation of fat in the breasts (gynaecomastia) and in rare cases, sleep apnea (a potentially life-threatening condition in which breathing is interrupted during sleep).

Dealing with menopause also entails making lifestyle changes — cutting down on smoking and drinking (which can induce early andropause), and maintaining a balance between the pressures of a career and mental peace.

Dr Reddy cautions that HRT is unsuitable for men with prostate enlargement, in those whom HDL cholesterol levels are very low and in men whose haemoglobin levels are very high (reflected in heart conditions and bleeding disorders, among others).

HRT can be administered through pills and injections, with oral pills being safer as they bypass the liver. In some injectible forms, testosterone is processed with certain reagents to make it more easily absorbable, but these can damage the liver, he explains. Another drawback with injections is that they cause peaks and troughs in hormone levels, which, in turn, provoke mood swings and physical reactions. The estimated cost of injections is Rs 200 a month whereas pills can cost Rs 900.

The Andropause Clinic has been set up not only to treat people but also put together a database on all issues related to male menopause, says Dr Reddy. Ideally, any physician should be able to deal with it ("it need not be a super speciality") so that the larger population can benefit and costs can be kept down, he adds.

Picture by Shaju John

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