For Victor Meldrew, from One Foot In The Grave, it was a defining characteristic of his character. Basil Fawlty was definitely in trouble. And in the real world, Oscar-winning actor Jeremy Irons blamed his mood swings after he turned 50.
Yet many doctors say that it is a myth conceived in a test tube by profit-oriented pharmaceutical companies.
I'm talking about the male menopause. Yes, the male menopause.
Presumably to miss middle-aged bloosters, some GPs prefer a more masculine description, & # 39; irritable man syndrome & # 39; – defined in the dictionary as & # 39; a behavioral state of nervousness, irritability, lethargy and depression that occurs in adult mammals after pregnancy cessation. testosterone & # 39 ;.
There was no rhyme or reason for the blush – they often occurred in the evening when I thought I was relaxed, or while I had a cup of tea and was reading a book
I laughed out loud when a (female) friend suggested a few months ago that the male menopause might be the reason that I am having trouble sleeping and that I also suffer from sporadic hot flashes.
There was no rhyme or reason for the blush – they often appeared in the evening when I thought I was relaxed, or while I was having a cup of tea and reading a book.
Sometimes I broke out in a cold sweat. My face would turn pink. A minute later everything would be normal again.
The biggest problem was falling asleep. Sometimes I would throw and spin for two hours, constantly checking the clock, before I finally quit. I bought some herbal pills from the pharmacy, but they only worked occasionally.
The biggest problem was falling asleep. Sometimes I would throw and spin for two hours, constantly checking the clock, before I finally quit
The expectation of yet another sleepless night made me invariably irritable the following evening.
Was this the male menopause?
Frankly, the idea was deadly. It's bad enough that my hair is getting thinner. I would never have lived from the ripples of friends and family. In fact, I had never told them.
But something was wrong. My diet has not changed, my weight is almost the same as ten years ago, and I take the same vitamins – echinachea to avert colds, vitamin B to boost my losing battle to get a bald spot of Friar Tuck and vitamin prevent C because I was brought up to think it was good for me.
Then I saw the monthly email from my doctor, Dan Wright, the medical director of Freedom Health on Harley Street. Talk about it in time. It was headlined: & # 39; Male Menopause & # 39 ;.
I was intrigued. He wrote: & # 39; We've all heard of the menopause. It is usually a condition associated with women as they age. You may be surprised to hear that menopause can also occur in men. "I was not surprised but surprised because he is a good doctor.
The email continued: & # 39; The male menopause usually affects men over 50. The condition is also called testosterone deficiency, androgen deficiency or late-onset hypogonadism. & # 39; The symptoms mentioned include problems with sleeping, mood swings, forgetfulness, fatigue, hot flashes, fat build-up on the abdomen and hair loss.
It was a Eureka moment.
& # 39; it's me, & # 39; I thought. I was on the phone right away to make an appointment. And then I went on the internet and discovered that the debate about the existence of the male menopause had been going back and forth for over 65 years.
Even the British Medical Journal learned on the subject in 2000, conducting a series of articles by experts on both sides of the argument. A paper from the Center for Men & # 39; s Health in London, published in the Journal of Aging in 2015, reported symptoms such as joint pain, low libido, and depression. Governments have spent money on research.
It was a Eureka moment. & # 39; it's me, & # 39; I thought. I was on the phone right away to make an appointment
Other doctors, I also discovered, refer to it as the andropause. There is even an Andropause Society, based in Hampshire, to increase public, medical and scientific awareness of the short and long term effects of testosterone deficiency syndrome (or & # 39; male menopause & # 39;) & # 39 ;.
Society also wants to gain more insight into how the condition contributes to type 2 diabetes, obesity, high blood pressure and heart diseases (see box below).
But many doctors studying the effects of aging sniffily reject the male menopause as a fiction invented for the benefit of grumpy hypochondriacs.
Swimming my head with these new facts, four weeks ago I was in the comfortable room of Dr. Wright. After hearing my list of aches and pains, he first decided to do a & # 39; goedemann & # 39; check, looking at my weight, height, blood pressure and cholesterol level.
Swimming my head with these new facts, four weeks ago I was in the comfortable room of Dr. Wright
There was a urine test for type 2 diabetes and a kidney infection and I had to spit into a tube to check my lung capacity. I passed on everything with flying colors.
Blood tests were found to exclude anemia and hepatic impairment. But as part of the research I was told that I had to eat a lot of red meat, eggs and tuna.
That's because vitamin D can help raise testosterone levels by 90%, according to researchers from Graz Medical University in Austria. If you don't get much sun like me, add more tuna and eggs to your diet.
And I'll eat meat too, because a meat-free diet is supposed to lower testosterone levels – but all things in moderation, of course.
So it's crazy enough back to the butcher, because I've been living on a diet with grilled chicken and white fish for years.
When Dr. Wright broached the sensitive subject of male menopause, saying: & # 39; Some people downplay its meaning by calling it a midlife crisis. I believe that it is a medical condition and that a male menopause can have a serious effect on the well-being of a man. & # 39;
Whether you call it the menopause or midlife crisis, the symptoms are related to the testosterone that is produced in our body. Repeated studies have shown that the level of men decreases as they get older: with 70 years they have between 25 and 50 percent less than men who are 20. This is a truth that is recognized by both male menopause supporters and by refuseniks.
Where there is disagreement about the effects of this fall.
I decided to have my levels tested – the test is called the andropause profile and it looks at various substances related to how much testosterone is in your body. Important factors are, for example, your levels of luteinizing hormone (LH) and follicle simulating hormone (FSH).
Dr. Wright explained that these are produced by the pituitary gland, at the base of the brain, and work together to regulate testosterone production in the testes.
Then there is something called DHEA (dehydroepiandrosterone), a form of sex hormone that is present in the blood of both men and women. This can be changed by the body to stronger hormones such as testosterone or to the female hormone estrogen.
Was this the male menopause? Frankly, the idea was deadly. It's bad enough that my hair is getting thinner. I would never have lived from the ripples of friends and family. In fact, I never told them (file image)
SHBG (or sex hormone binding globulin) is a protein made by your liver that binds tightly to three sex hormones found in both men and women – estrogen, dihydrotestosterone (DHT) and testosterone. SHBG carries these three hormones through your blood and significantly determines the amount of testosterone that your body tissues can use.
Finally there is your testosterone. This is an androgen – that is, it stimulates the development of male characteristics. The test also looks at your & # 39; free androgen index & # 39 ;, which measures the testosterone in your blood and compares it with the total amount of testosterone and SHBG in your body.
Know the symptoms …
Do you think you are going through the male menopause? To be able to offer testosterone testing to the NHS, you must meet one or more of the following criteria, such as:
- Persistent loss of libido and / or erectile dysfunction
The blood tests were taken in the morning because the testosterone levels, which fluctuate during the day, are at their very first highest point. There are two treatments recommended by Dr. Wright. They are the Nebido injection, in the buttock, which contains a long-acting form of testosterone – the effect lasts about three months (it costs £ 150 for the puncture only). Or there is Testo-gel, a short-acting form that you put on your arm every day, which costs around £ 30 and also lasts for three months. Both treatments are only available on prescription.
While waiting for the results of my test, I found a report that showed that testosterone requirements increased by 20 percent between 2012 and 2016 and cost the NHS £ 20 million a year. Is this a sign that doctors are handling the problem in larger numbers? Or are we becoming middle-aged men who become complacent hypochondriacs?
Dr. Wright does not doubt that it is a major problem. & # 39; Although testosterone gradually decreases with age, there is disagreement about why.
Many doctors studying the effects of aging sniffily reject male menopause as a fiction invented for the benefit of grumpy hypochondriacs (file image)
& # 39; I think extreme stress is a factor that can be caused by the breakup of relationships, family death, illness or pressure at work – there are indications that high levels of cortisol (the stress hormone) suppress testosterone. & # 39;
My test results came through 24 hours later. Disturbed by the prospect that I could have the problem, I rightly assumed that people would laugh at me. My partner certainly did it: his advice was to bring myself together and go to bed earlier.
The following day Dr. Wright good news. The healthy range for testosterone is 7.6 to 31.4 and mine came in at a comfortable 22.6, so I have no male menopause.
Phew. So what's my problem?
The doctor had already determined that before I go to bed, I always see a burst of news on TV – after all, I am a journalist. & # 39; It's the worst thing you can do if you live a stressful life and work long days & # 39 ;, Dr. Wright explains.
It seems that television sets emit a blue light that can trigger the brain to stop making melatonin, the hormone that helps you sleep.
& # 39; Even if your eyelids hang while watching TV, this can affect your sleep pattern & # 39 ;, he tells me.
And the hot flashes? I think he worked that out too. I have incised my caffeine intake from a maximum of 14 cups of tea per day to three. And, touch wood, a month after I did that, the flushes stopped.
Why are doctors still divided about the male change in the middle of life?
The term & # 39; male menopause & # 39; was invented in 1944 by researchers Carl Heller and Gordon Myers to describe a series of symptoms that reflect the symptoms of menopausal women, including depression, anxiety, loss of libido, lack of energy and sometimes hot flashes.
The blame is usually set right on falling levels of the male sex hormone testosterone. But the male menopause, also known as andropause, is not a medically recognized term.
Moreover, there is no evidence that healthy men, when they are middle-aged, experience a sudden, dramatic decrease in sex hormones that is equivalent to that of women.
Dr. Quinton simply says that the male menopause does not exist. Instead, men who experience symptoms such as mood swings and lethargy usually suffer from the effects of other age-related diseases
According to the NHS website, the term & # 39; male menopause is & # 39; misleading because & although testosterone levels decrease as men get older, the decrease is stable from less than 2 percent per year from the age of 30 to 40, and it is unlikely that this causes problems on its own. & # 39;
But this has been hotly debated and, as a result, men who say they are suffering can struggle to get treatment at the NHS.
& # 39; I have been listening to patient stories for 15 years and I am convinced that the male menopause is real & # 39 ;, says Dr. Clive Morrison, a GP at the Center for Men & # 39; s Health in London. & # 39; Most patients do not receive the treatment they need, and that is very sad. & # 39;
And there is research suggesting that something is really wrong.
A study conducted by the Center for Men & # 39; s Health and University College Hospital, in London, of 2000 men with an average age of 54 who reported symptoms of male menopause, including loss of libido and depression, found that these symptoms improved After the men had testosterone replacement therapy – the male hormone testosterone, administered as a gel, cream, tablet or implant.
And that despite the fact that 83 percent of those in the study – published in 2015 in The Aging Male magazine – had testosterone levels that were considered in the normal range – that is, roughly between 10.4 and 41.6 nmol / l . (nanomoles per liter of blood). This means that testosterone deficiency in older men is much more common than current screening methods suggest, possibly because different men need different levels of the hormone to become normal & # 39; normal & # 39; to feel.
There were some concerns about the study. Dr. Richard Quinton, a consultant endocrinologist at the University of Newcastle, says it & # 39; unreliable and poorly designed & # 39; so the results should not be taken too seriously.
Frederick Wu, professor of medicine and endocrinology at the Manchester Royal Infirmary, warns against offering therapy to men who have no proven testosterone deficiency.
& # 39; If the testosterone levels are within the normal range, the symptoms would not be caused by testosterone deficiency and there is no indication for a testosterone replacement therapy, which will not only be ineffective but can cause side effects when used in higher doses, & # 39; he says.
Older men who receive long-term treatment with testosterone may have a higher risk of cardiovascular problems such as heart attacks and strokes. Testosterone is known to increase thromboxane production, a compound that narrows blood vessels and can increase the risk of blood clots. A small number of men may develop swelling or tenderness of the breasts, acne or swollen ankles.
GPs can order blood tests to measure testosterone levels if they suspect that there is a real medical problem – for example, late-onset hypogonadism caused by a dramatic fall in circulating testosterone when testes produce little or no hormones. It can occur in middle-aged men who are obese or have type 2 diabetes, and is linked to high body fat.
However, the condition is not common and affects only about 1 percent of men over the age of 65. Currently there are only men who have a testosterone deficiency – in other words, their blood tests show levels of less than 10 nmol / l (the definition of a deficiency may vary slightly, as there are no NICE guidelines for diagnostic levels), be referred to an NHS endocrinologist, a specialist in hormone problems.
For this small group of patients, testosterone replacement therapy, administered as a gel or by injection, can relieve symptoms.
GPs can order blood tests to measure testosterone levels if they suspect that there is a real medical problem (file image)
The mainstream is robust against the idea of a male menopause.
Dr. Quinton simply says that the male menopause does not exist. Instead, men who experience symptoms such as mood swings and listlessness usually suffer from the effects of other age-related illnesses and problems such as obesity and type 2 diabetes, which can affect hormone secretion and lower testosterone levels.
He agrees that the testosterone levels do decrease slightly with age, but says that the & # 39; vast majority & # 39; of men & # 39; retains the ability to produce sufficient testosterone into old age & # 39 ;.
The symptoms that men cause compared to male menopause, such as loss of libido, may be caused by other factors, he suggests. Loss of desire and erectile dysfunction can be caused by stress and anxiety. & # 39; There are also physical reasons for erectile dysfunction, such as cardiovascular disease and high blood pressure, which occur more frequently as men get older & # 39 ;, Dr. Quinton adds.
But is it possible that for some men the slight decrease in hormones is sufficient to cause problems that it would not be for others, as the 2015 researchers suggested?
They concluded that & # 39; many & # 39; men who may benefit from treatment & # 39; remain untreated due to excessive reliance on laboratory measurements of androgens for diagnosis and treatment & # 39 ;. In other words, men should be treated based on their symptoms rather than blood tests. Men with symptoms of a male menopause whose hormone levels appear to be normal during NHS laboratory check-ups can seek help from a number of private private clinics for men.
Doctors in many of these clinics look at both symptoms and blood tests and may opt for more sensitive active testosterone tests, as recommended by the British Society of Sexual Medicine guidelines.
& # 39; Total testosterone checks, often used by general practitioners, measure all testosterone, including so-called & # 39; free & # 39; testosterone and bound testosterone, which means that the testosterone is bound to a protein called SHBG, making it inactive & # 39 ;, says Dr. Morrison.
& # 39; For some men, total testosterone is the right measure, but for others it may be far away. Every man is an individual and testosterone deficiency is not the same for everyone. & # 39;
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