The Down Side ; It's Normal for Your Middle-age Guy to Have a Gradual Drop in Hormone Levels

AlbuquerqueJournal 02-07-06

Is your middle age fellow going through "the change?" Don't snicker. Medical professionals increasingly are putting a label on symptoms experienced by middle-age men -- ranging from decreased sexual drive to depression. They may be a result of lower testosterone levels that are a normal part of aging.

Andropause is the name given to the hormone-related condition of low testosterone that usually occurs in males age 40 and older.

Keeping silent

It's a time and a condition that can wreak havoc on a marriage, particularly if men don't acknowledge or want to talk about sexual problems and their women partners interpret the changes in the relationship as a personal sexual rejection".

It can be devastating to a woman's self-esteem," said psychotherapist Tamara Auger, who works with couples in her private practice. "Women tend to take it very personally, and the men don't want to talk about it."

In a culture that promotes male sexuality -- it's part of our belief system that men are always ready to have sex -- a man's diminished sexual drive or performance can cause pain and confusion for both partners, according to Auger.

Recognizing that the problem is a medical condition that can improve with treatment is a step in the right direction. Improving communication skills between couples is another.

"It can be a great time to build in more communication and intimacy in a relationship, which is what women usually say they want," Auger said.

Gradual changes

While men don't have a clear-cut midlife signpost such as the cessation of menstruation, they do experience gradual bodily changes.

The transition known as andropause may span several decades. Physical changes may be accompanied by a loss of energy, sex drive and physical agility, as well as changes in moods and attitudes.

"Andropause is a confusing subject," said Robert Galagan, an endocrinologist with Presbyterian Healthcare. "But it's true -- the older men get, the more have issues with sex drive and function, stamina and vigor. The question becomes: Is this a normal physiological decline in testosterone production?"

Other conditions

The issue of andropause, Galagan adds, is even murkier when lumped together with other midlife changes and medical conditions.

Many medications can impair sexual responses. Andropause also comes at a time in life when many men are questioning their life accomplishments or experiencing a diminishing role at work. As a result, they may be prone to depression regardless of hormonal levels.

Medical researchers can agree, however, that testosterone levels generally drop by about 10 percent every decade after men turn 30. After that, symptoms can be vague and can vary widely among individuals. Or, symptoms can be nonexistent.

"Personally, I don't believe there is a male menopause," said Albuquerque psychotherapist Joan K. Rossman. "Yes, over the lifetime of a man, testosterone levels gradually decrease, but it begins when he's quite young. It's not like menopause, in which a woman has a precipitous drop in estrogen with all kinds of results."

Waning desire

The most common complaint of men with low testosterone levels, the professionals agree, is decreased sex drive and erections that might be less strong.

Other typical problems can include decreased muscle mass and loss of muscle strength, increased upper and central body fat, osteoporosis and back pain, and emotional, psychological and behavioral changes.

Testosterone is a hormone produced in the testes and in the adrenal glands. It helps to build protein and is essential for normal sexual behavior and producing erections. It also affects many metabolic activities, ranging from bone formation to liver function

Testosterone levels can be checked with a simple blood test, according to Galagan, and many men are good candidates for testosterone replacement therapy, typically applied daily through a cream or patch. "If a man has lost sex drive, has diminished sexual function, is over the age of 50 and feels stamina is waning, it's reasonable to get testosterone levels checked," said the physician. "If it comes out below normal, most doctors would offer a trial of testosterone replacement."

Correct diagnosis

Some medical conditions such as prostate cancer, however, preclude hormone treatment. Part of the difficulty in diagnosing andropause, Galagan said, is that other medical conditions ranging from depression to a psychological "slump" can affect sexual function and even testosterone levels.

"As men get older and retire, some are not as actively engaged in their lives," he said. "It's important just to get out and do things. Sometimes testosterone levels improve without treatment."