Male Menopause (Andropause)

Introduction

Male menopause is a lot more subtle than menopause in women. Many men have male potency until late in life. However, there are a significant number of men who get male impotence, also termed "erectile dysfunction" (=ED). This problem usually occurs in middle aged men.

Diagnostic tests

A significant number of these men have low testosterone levels when they are tested as well as increased levels of LH and FSH. It is generally accepted that the reason for this is that the testicles no longer produce enough testosterone. However, there might be a significant number of men who are producing less testosterone due to inhibitory mechanisms of the gonadotropin hormone production at the level of the pituitary gland.

If the man is overweight and has a history or diabetes or hypertension, there is a good chance that this man would suffer from the syndrome of insulin resistance. In this case there is an inhibitory action on the pituitary gland by interfering with cyclic AMP production, which in turn leads to lower testosterone production. As I outlined under the link above, this knowledge has some practical implications as the low testosterone in this case is only a symptom, not the cause of the erectile dysfunction. This has also some therapeutic implications as we will see below.

Symptoms

Other health problems such as cardiac problems, pulmonary problems like emphysema, hypertension and diabetes have a lot to do with erectile dysfunction.

However, all of these medical ailments are usually treated with a variety of drugs causing impotence. Such drugs as diuretics, many antidepressants, pain medications, alcohol, cocaine, anxiolytics and cimetidine (an anti-acid medication) are all known to cause erectile dysfunction. Some hormonal problems such as hypo- and hyperthyroidism as well as Cushing's syndrome are also known to cause erectile dysfunction. Diabetes and impotence are also connected.

Impotence Treatment

It follows from what was said above that all the factors that can be identified , which have a negative bearing on erectile dysfunction, should be treated first. This includes a thorough history and physical examination by your family physician, a review of drugs, alcohol consumption and medications.

Next there should be a life style change, which includes a zone diet program (Ref.1 and 12), a regular brisk walking program and relaxation exercises including meditation and hypnosis. Often the change of all of these factors will have a beneficial effect on the hormone balance to the point where within 3 to 4 weeks a normal sexual function returns due to the returning of the normal gonadotropin function (insulin resistance is disappearing).

In recent years an attractive alternative to impotence pills like Viagra has come into the forefront. Testosterone treatment with bioidentical hormone has been found to be safe (Ref.16). However, this should not be looked at in isolation as testosterone derives from progesterone and in Ref. 17 estrogen and progesterone combination therapy is suggested rather than tesosterone treatment alone, in the sense of an anti-aging apprach. This has been reviewed by me in a separate chapter ("Antiaging for women and men").

If all of these measures do not help, an impotence pill such as sildenafil (brandname: Viagra) and others of that type can be considered. However, there are a significant number of side effects with this medication such as headaches and clotting problems that limit the use for certain patients. As already stated bioidentical testosterone replacement therapy, which can stimulate libido significantly (Ref. 17), can be very useful. In the past, with the use of synthetic tesosterone, hepatic toxicity and with longterm use the risk of liver cancer existed. Dr. Morgentaler has shown that prostate cancer is not a risk with longterm use of bioidentical testosterone (Ref.16). Also, with synthetic testosterone blood could get thickened (secondary polycythemia), which could cause a stroke. Patients on synthetic testosterone need to be monitored for these side effects accordingly, but not on bioidentical testosterone. Viagra might be useful in some patients, if cardiovascular problems allow this and erectile dysfunction is a prominent symptom. Ask your doctor about this who can explain to you side-effects in more detail.

Disclaimer

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References

1. B. Sears: "The age-free zone". Regan Books, Harper Collins, 2000.

2. R.A. Vogel: Clin Cardiol 20(1997): 426-432.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 8: Thyroid disorders.

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 7:Pituitary disorders.

5. J Levron et al.: Fertil Steril 2000 Nov;74(5):925-929.

6. AJ Patwardhan et. al.: Neurology 2000 Jun 27;54(12):2218-2223.

7. ME Flett et al.: Br J Surg 1999 Oct;86(10):1280-1283.

8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 261: Congenital anomalies.

9. AC Hackney : Curr Pharm Des 2001 Mar;7(4):261-273.

10. JA Tash et al. : Urology 2000 Oct 1;56(4):669.

11. D Prandstraller et al.: Pediatr Cardiol 1999 Mar-Apr;20(2):108-112.

12. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

13. J Bain: Can Fam Physician 2001 Jan;47:91-97.

14. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

15. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

16. Abraham Morgentaler, MD "Testosterone for Life - Recharge your vitality, sex drive, muscle mass and overall health", McGraw-Hill, 2008

17. Dr. Volker Rimkus: "Die Rimkus-Methode - Eine natuerliche Hormonersatztherapie fuer den Mann", Verlag Mainz, 2006 (in German)

Last Modified: Dec. 9, 2008