Do Men Experience Menopause?
Mood and Libido
Red sports cars, hair transplants, cheesy affairs followed by even cheesier divorces: The male midlife crisis, cartoonlike though it may seem, does hold some reality. Now a lot of people are blaming that reality on one hormone, testosterone, and dubbing it "male menopause."
A lot of people are wrong.
"All women go through menopause. There's nothing in men that's so clear cut," says psychiatrist Harvey Sternbach of the UCLA Neuropsychiatric Institute in Los Angeles, who published an exhaustive review of studies on the topic last year. "My own reviewers didn't want me to put `male menopause' in the title, because it's so controversial." He ended up writing about "age-associated testosterone decline" in men. Irritability, depression, and sexual problems have been linked to low testosterone, which could affect half of all men in the United States.
The trouble is the one half. If half do have depleted testosterone, half don't, which makes it hard to argue this is a genderwide phenomenon. The hormone also starts dropping once men hit their 30s, which doesn't make it an ideal culprit for events that occur 20 years later. That hasn't stopped psychotherapists such as Jed Diamond from writing a Book-of-the-Month Club selection called Male Menopause or pop Passages-maker Gail Sheehy from arguing that an avalanche of Viagra prescriptions proves that a "manopause" exists.
Endocrinologist Adrian Dobs of the Johns Hopkins School of Medicine in Baltimore believes the hormone is part of a midlife change but not the whole story. Other hormones change as well, including pituitary and growth hormones and another one called DHEA, and these fluctuations don't happen at the same time. There are also psychosocial changes, such as new family dynamics after grown children leave home. "It's a big, complex picture," Sternbach says. "You have to look at everything that's going on in a man's life."
Hormone blues. There does seem to be a strong link between low testosterone and depression. One study of 850 men over age 50 showed the lower the hormone levels, the higher their scores on a depression test. A much smaller study of depressed men showed those who didn't get better on antidepressants did improve after testosterone supplements were added to the mix.
Sexual potency also drops with testosterone level, and that's where fast cars and affairs can come in. "Loss of potency is scary," says Sternbach. "Low testosterone can be tied to a growing sense of figurative and literal impotence, and therefore tied to doing things to compensate."
That doesn't mean that any man with midlife malaise should go on testosterone replacement therapy. There are dangers, the biggest being elevated risk for prostate cancer. Hardly worth it, doctors say, if testosterone isn't really at the root of the problem.
This story appears in the July 30, 2001 print edition of U.S. News & World Report.
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