With more and more senior citizens living longer, and seeking and demanding healthier more fulfilling lives, the past decade has seen major advances in the perception and medical understanding of changes in physical, mental and emotional health of older men which were previously dismissed as‘normal aging’. It is now possible to distinguish normal age related decline in male hormone (androgen) levels from a clinical condition where a variety of physical, mental and sexual symptoms are caused by low androgen levels – and are thus eminently treatable by androgen replacement therapy. The size of the problem is large; it has been estimated that up to 2.5% of men as young as 40 can be suffering from this, and the condition can be present in 30- 70% of men in their 70s. A survey in 2005 in the four metros found that almost 75% of men above 40 reported some features of hypogonadism (deficiency of sex hormones). The medical community has however, and with good reason, been a bit guarded in recommending casual or nonspecialist diagnosis and treatment. This is because on the one hand the signs and symptoms are subtle and there are no straight forward diagnostic tests with clear-cut normal and abnormal values, and on the other hand treatment can have potentially serious side effects if used indiscriminately or without proper monitoring.Typical symptoms include decreased energy and chronic fatigue, sleep disturbances, mood changes and difficulty concentrating, and reduced sexual drive. Specialist evaluation will show signs of decreased muscle mass, decreased bone density, increased visceral fat and hormonal abnormalities. All these symptoms can clearly also be due to other unrelated causes including financial and health related stress around retirement age, difficulty coping with changing relationships or death of a loved one etc. – all major events which can start impacting one’s quality of life at about the same time. Physical signs of androgen deficiency can similarly be mimicked by the tendency to put on weight in middle age, sedentary lifestyle, alcohol abuse and decreasing androgen levels due to something called the metabolic syndrome – a combination of inter-related disorders which increase the risk of heart disease, diabetes etc. The main features of metabolic syndrome are putting on weight around the waist, high blood pressure, low ‘good cholesterol’ and tendency for diabetes. Recent research has shown that metabolic syndrome and age-related hypogonadism can be both cause and effect of each other. Therefore the potential benefits of recognizing and treating ‘male menopause’ (or Symptomatic Late Onset Hypogonadism, to use the more accurate medical term) include not only improving the overall quality of life and sense of well being, but also prevent more well known killer diseases like heart disease, diabetes,blood pressure etc. That is why experts the world over are coming to the consensus that in the presence of typical symptoms and documented hypogonadism, hormone replacement therapy is valid and effective. There is also a cautionary note however: because the diagnosis requires astute clinical judgement and treatment can have potentially serious side effects (like heart and liver dysfunction and the theoretical risk of prostate cancer), hormone replacement therapy should only be started after excluding anyprostatic abnormality, And be carried out under specialist supervision and lifelong monitoring. Any concern about the prostate at any stage should warrant immediate urology referral. Male menopause is therefore very much a reality and can seriously compromise quality of life for ever increasing numbers of men in their sunset years. But with very effective treatment available we all need to believe that getting old may be natural but feeling old is now optional.
The Writer is the
Clinical Director & Chief of Urology
Dr Ramayya's UrologyNephrology Institute and Hospitals Pvt. Ltd.