Male menopause

W e have been hearing a lot more discussion about menopause recently. The conversation has been opening up at a more public level, and increasing numbers of aesthetics clinics are now incorporating treatments such as Bioidentical Hormone Replacement Therapy (BHRT) into their offering to support the overall health and wellbeing of their peri-menopausal female patients. But what is little talked about is the male menopause or “andropause”.

From the age of 30, testosterone levels in males start to decline. Testosterone is a much-needed hormone in a man’s body, and declining levels can lead to an array of symptoms, which can often be mistaken for unhealthy lifestyle factors or a mid-life crisis.

Symptoms such as low mood, a loss of interest in sex, weight gain, fatigue, hot flushes, low confidence and disinterest in life can all be caused by declining testosterone levels. It is thought that as many as one in five men experience symptoms of andropause.

Rizvan Faruk Batha MPharm, PGDip GPP, IPresc, MRPharmS, superintendent pharmacist and director of operations at Specialist Pharmacy, comments, “As levels of testosterone decline during the andropause, a significant effect can be seen in a male’s appearance.

“Testosterone is important in the regulation of sebum production, skin regeneration and the thickness of the dermis, so a reduction can cause sagging, dryness and wrinkling. It’s needed for the growth of hair follicles in the beard, armpits and pubic area and is associated with the anagen or growth phase, so a reduction can lead to hair loss in these areas. The physique can also be affected as testosterone is needed for muscle mass, and its decline, as well as that of oestrogen, can promote body fat and a redistribution of fat, especially around the abdomen.”

Many men who present to their GP with such symptoms are often prescribed antidepressants or are told to look at lifestyle factors such as drinking less alcohol, eating healthier or doing more exercise. However, these lifestyle changes, which can contribute to feeling better, do not always help rebalance testosterone levels, while anti-depressants can sometimes dampen testosterone levels even further.

As levels of testosterone decline during andropause, a significant effect can be seen in a male’s appearance

Low testosterone can have a huge effect on a man’s life from impacting their performance at work with memory issues and even affect their appearance, with weight gain and hair loss being common symptoms. All of this combined with low confidence levels can leave men feeling they have completely lost themselves, their identity and their sense of purpose.

Another important hormone for males is DHEA, a steroid hormone that is produced mainly by the adrenal glands and a small amount in the testes. It is a major precursor to stronger androgens such as testosterone and is known to increase energy levels, enhance wellbeing and boost the immune system. DHEA levels rapidly rise from puberty, continuing to rise until early adulthood (25 to 30 years of age). After the age of 30, production begins to decline at a rate of around 2% per year, and this decline often correlates with the signs and symptoms of ageing.

DHEA plays an important role in resistance to disease, with low levels being linked to increased susceptibility to ageing and disease. DHEA deficiency is very often linked with fatigue, lack of motivation, aching joints, loss of muscle tone (atrophy), weight gain and depression, usually, because a low level of DHEA will impact the body’s ability to produce testosterone, which increases symptoms of the andropause.

TREATMENT

“A simple blood test checking levels of testosterone and DHEA for men in their early 50s can easily spot low levels and should be the first thing to check when men present with these symptoms”, advises Batha.

The andropause can be simply and easily treated with Testosterone Replacement Therapy (TRT) and DHEA. The symptoms of andropause are a result of low testosterone, and as such, testosterone replacement therapy (TRT) is an effective treatment.

Bioidentical testosterone is identical to the testosterone produced in the body, and the doses are personalised, meaning men can receive as little or as much testosterone as they need to restore their levels. It is always prescribed in the form of a cream, gel or lozenge so that it is absorbed directly into the bloodstream. Bioidentical DHEA is usually prescribed in capsule form.