Breaking News in Urology

January 04, 1998

Menopause May Be a Fact of Life for Men, Too

c. Seattle Post-Intelligencer

At 55, J.B. Webster seems to have weathered midlife fairly well. He's got a 2-year-old daughter, a young wife he lovingly calls his "bride," a satisfying career as a West Seattle realtor, and, as he delicately puts it, "plenty of my share of testosterone."

Trim, with a full head of dark hair, he's often taken for a younger man. Never mind the divorce, depression, unemployment and career change he navigated to reach this point. What bothers him most about midlife are the nagging signs that the Teflon is wearing thin on his jock body.

He's gained 20 pounds in the five years since a back injury forced him to give up running. Even softball with his buddies took a dangerous turn when his childhood allergies flared up during a game and left him breathless. Then there are those wee-hour trips to the bathroom that started a few years back.

"I can't do with my body what I could do at 18 up to 50, and not give it a second thought," Webster says with a flicker of consternation. For men in midlife, it's a familiar story with a new and controversial name: male menopause.

The term, which literally means cessation of menses, sends shudders through some medical professionals, who point out that since men don't have periods, there's nothing to "pause."

Nevertheless, there's growing respect for the possibility that at least some men experience a hormonally driven change of life that can affect everything from libido and body fat to mood swings. Whether these changes are universal or confined to a small group of men is hotly contested.

Male menopause was largely treated as a joke in popular culture until 1993, when journalist Gail Sheehy wrote a Vanity Fair article suggesting that many men go through an "unspeakable passage" surrounded by secrecy and shame. She elaborated two years later in her book, "New Passages: Mapping Your Life Across Time" (Ballantine Books, 498 pages, $12.95 paper).

"Although it is not strictly a menopause," Sheehy wrote, "many men in middle or later life do experience a lapse in virility and vitality and a decline in well-being." For some men, Webster believes, this period includes a crisis of meaning fueled by years of competition and disconnection from self and others. He said the question becomes, "Is that all there is? Jeez, is that all there is to winning?"

The topic rears its head in a new compendium about life after 50, titled "Are You Old Enough to Read this Book?" edited by Deborah H. DeFord (Reader's Digest, 192 pages, $21).

"While scientists disagree about male menopause, the ultimate experts on the subject _ middle-aged men themselves _ express few doubts that it exists, writes Cyra McFadden, who polled a dozen men ages 45 to 70 for her chapter, "Is There Really a Male Menopause?"

Many shared the sentiment of 60-year-old songwriter and piano player Dave Frishberg: "Gee, I hope there's such as thing as male menopause. Because if there isn't ... what was that?"

Therapist Jed Diamond, a nationally known men's-movement leader, says he was skeptical until he began researching _ yes _ his own book. He thought he might use the European terms "andropause" or "viropause," or perhaps the fanciful "man-o-pause." But four years of research, including a survey of 100 menand 100 women, convinced him that men's and women's midlife transitions are more alike than different. So he called the book simply "Male Menopause" (Sourcebook Inc., 358 pages, $22.95).

Diamond, who directs the Men's Health Clinic at the Long Valley (Calif.) Health Center estimates more than 25 million American men between ages 40 and 55 are now going through the "male menopausal passage." He expects the number to more than double by the year 2020.

Diamond, who reviewed European and American studies on aging, says that while men's hormone levels don't plummet as estrogen does in menopausal women, they decline enough to cause a host of troubling symptoms _ hair loss, irritability, depression, forgetfulness, reduced sexual desire and impotence.

"Men know SOMETHING exists," said Diamond, 54, "but there's such a fear that what it is is loss. A lot of what we've associated with getting older really is disease and can be prevented. This stage of life is really a positive one." Like Sheehy, he views male menopause as a transition to the second half of life, a time when men should finally settle down and be grown-ups.

"Living as a 30-year-old when you're 60 is not a productive life," Diamond said "What I call on men to do is take on a role as mentors, as guides for younger men in society."

Bert Hoff of Seattle, who manages two Web sites on men's issues, said he was "very cynical" about the existence of male menopause until Diamond sent him a draft of his book.

"What is male menopause?" Hoff wondered. "Is this just claiming that women are hurting, so men have to be victims, too?" Hoff says he's now "very totally convinced." "We don't talk about it, and we need to talk about it more," said Hoff, 53. "You start to think that there's something wrong with you, that you're defective and different."

Hoff is so sold on the concept, he even suspects that cyclical ups and downs of testosterone affect his tolerance for the everyday irritations of life _ sort of like a male PMS. Some days, for instance, he's unruffled when online clients get overly aggressive and launch "flame wars." "Other times," he said, "I'll be somewhere else in my 'cycle' and I'll instantly be outraged."

That drew a skeptical chuckle from Dr. Alvin Matsumoto at Seattle's VA hospital, who specializes in the study of old age and hormones. And yet, Matsumoto reflected, testosterone deficiency can result in irritability. "I do believe there are behavioral changes related to testosterone," he said, adding that testosterone levels fluctuate normally. "There definitely is a circadian variation," he said.

"Whether there's seasonal or monthly variations, I think is less clear." Such research lags several decades behind the study of menopause in women, which explains why opinion is so divided over the existence of a male change of life.

Some of the harshest words come from John McKinlay, director of New England Research Institutes, who led the largest and most comprehensive study of male sexuality and health since the Kinsey report more than 40 years ago.

The federally funded Massachusetts Male Aging Study, conducted from 1987 to 1989, surveyed more than 1,700 Boston-area men ages 40 to 70. The study was published in the January 1994 issue of The Journal of Urology, and research is ongoing.

In one startling finding, 52 percent reported some degree of impotence, suggesting erection problems affect nearly 20 million men nationally _ roughly twice the previous estimates. Five percent of the 40-year-olds, and 15 percent of the 70-year-olds, reported complete impotence. The study showed a consistent age-related decline in four measures of erectile functioning: frequency of erections, difficulty achieving and maintaining erections and incidence of erections upon awakening. Ejaculation problems also increased with age, while sexual desire declined.

Despite these trends, McKinlay says the notion of male menopause is "absurd" since men's testosterone levels typically drop only one-half of 1 percent per year after age 40. "We are inappropriately extrapolating from the female experience," said McKinlay, who sees "male menopause" as a cash cow for hormone hucksters.

"Hormone replacement therapy for men may go the same way as hormone replacement therapy for women," he said. "If we give men simple testosterone, it may increase prostate cancer. We may repeat the same mistakes for men that we made for women.

"The bottom line _ what this represents," McKinlay said, "is an attempt to medicalize aging and to dream up treatments for conditions that don't exist." Testosterone is only one of the hormones that drop in older men. Others include growth hormone, melatonin and the adrenal hormone DHEA.

Although more research is needed, Matsumoto said low testosterone may contribute to the loss of a sense of well-being, mood changes, problems with cognitive functioning and loss of muscle and bone mass. "I don't think a lot of people realize osteoporosis occurs in men as well as women," he said.

Prostate health is another major piece of the male-menopause puzzle. Diamond, noting that the prostate gland is the most frequently diseased organ of the body, said the major risks are prostatitis (prostate inflammation), enlarged prostate and prostate cancer. He cites one authority as saying, "A man's odds of getting one of these three diseases approaches 100 percent."

Drawing on the advice of holistic healers, Diamond advises men to look into the prostate-shrinking properties of zinc supplements and saw palmetto, a berry extract available at health food stores. He also cites a Harvard study showing that frequent servings of tomatoes reduce prostate cancer risk.

Hibbs, at Bastyr, agrees that saw palmetto is safe and effective. He suggests a high-potency variety labeled 85 to 95 percent liposterolic extract, at a beginning dose of 80 milligrams twice a day. Hibbs also recommends zinc supplements for men over 45 -- typically 30 to 60 milligrams a day, accompanied by 1 to 3 milligrams of copper to prevent copper depletion. Hibbs said pumpkin seeds (1/4 to 1/2 cup a day) and flaxseed oil (one teaspoon twice a day) also promote prostate health.

Diamond, easing gracefully into elderhood, said the point is to be healthy, fit and spiritually wise, not to chase after lost youth. "I will resist this notion of `Let's find the latest thing to stay young,' " Diamond said.

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