Dear Dr. G,

I am sorry to email you about a subject that is not so sexy.

I am a middle-aged man reaching the age of 50, and during the last three months of the movement control order (MCO), I haven’t been myself. I noticed my libido is almost non-existent and I am constantly feeling tired.

Initially, I thought it was related to the stress of Covid-19. However, despite the easing of the MCO, my condition is not improving.

My wife suggested that I see the doctor and reckons that it may be “male-menopause”

I just find the whole thing laughable; as everyone knows men simply don’t pause. However, I went to my doctor and reckons I have metabolic syndrome instead and apparently my high cholesterol, hypertension and glucose intolerance is responsible for the decline of my testosterone.

Now, I am all confused and I would like to put Dr. G on the spot.

Is there such a thing as male menopause, and am I going through it? If so, how is it diagnosed? What are the symptoms I experience with the condition, and can it be reversed?

Yours truly,
Paused Paul

Hormonal changes are a natural part of aging for both men and women. In a woman, the end of ovulation results in more dramatic plunge of the sex hormones, rendering a drastic emergence of certain associated symptoms.

On the other hand, the gradual decline in male sexual hormones tends to be associated with less drastic overall changes. This prompted the debate whether male menopause is real or just an urban myth.

Adding to the confusion of male menopause is the variation of the terminology for the condition. Many doctors use the term “andropause” to describe the symptoms of aging related to the declining hormone. Other commonly used names include testosterone deficiency syndrome (TDS), Androgen Deficiency of the Aging Male (ADAM) and Late Onset Hypogonadism (LOH).

Another obstacle for diagnosing male menopause is the variability of testosterone levels and its impact on different individuals. Testosterone levels differ greatlyamongst men. In general, older men tend to have lower testosterone compared to his younger days.

Some men also have lower than normal levels of the sex hormone, without any adverse symptoms.Therefore, the diagnosis of the condition is dependent on both medical history and laboratory investigations.

Testosterone influences many aspects of a man’s life. The decline of the hormone below a certain threshold can be associated with a barrage of symptoms.

The most obvious change noticeable by men is sexual performance. The decline in libido and even the emergence of sexual dysfunction such as erectile dysfunction (ED) are first observed. Many men also reported the shrinkage of their crown jewels rendering a decline of fertility. In addition, various bodily changes are also visible.

These include an increase in body fat which is often seen as a beer belly, reduced muscle bulk, and a decrease in bone density. The loss of bodily hair and the emergence of “man-boobs” or gynecomastia are also common complaints.

Lastly, low testosterone is also well recognized to contribute to the decrease in motivation, insomnia, irritability and loss of self-confidence. The general depiction of an aging man with his dwindling erection, expanding waistline and budding male breasts can also be perceived as a grumpy man experiencing his midlife crisis.

In fact, men as young as 40 are already experiencing the effects of declining hormones. Also, a long-term unhealthy lifestyle with smoking, excessive alcohol consumption, overeating and lack of exercise is generally associated with premature aging in men and the early onset of male menopause.

The utilization of Testosterone Replacement Therapy (TRT) is debated and controversial for the treatment of male menopause. Medical literature had documented the association of metabolic syndrome, namely hypertension, obesity, diabetes and dyslipidemia with early onset of male menopause.

Therefore, lifestyle changes and the treatment of blood pressure, glucose and cholesterol are generally the first steps to revive the dwindling fountain of youth. Of course, the initiation of a sustained healthier lifestyle is easier said than done.

Therefore the prospect of TRT is only reasonable when low level is confirmed, followed by stringent monitoring of the efficacy and adversity of therapy.

As a man progresses in his journey of life, the decline of testosterone is the dampening of his fountain of youth.

Indulging in life and a sedentary lifestyle can contribute to a depreciation of the sex hormone responsible for the drive inside and outside the bedroom and many men who endured three months of the MCO with a “forced” sedentary lifestyle and the stress of uncertain future are faced with further plummeting testosterone and the realization of looming male menopause.

As William Shakespeare says in Much Ado About Nothing,”a man loves the meat in his youth that he cannot endure in his age.”

Dr. G is constantly put on the spot on issues of Male Menopause or simply “Men-No-Pause” and his view is that if a man cannot endure the looming menopause with shrinking testicles, a beer belly, man-boobs and a dwindling sex drive, then the love of meat and a sedentary lifestyle will just need to take a pause!

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