Dr Nimesh Poudel considers it a very important discussion. If there are some who consider chances of men experiencing a phenomenon similar to that of a female menopause a myth, there are even more people who have never even heard of the condition. “Either way, awareness on the matter is long overdue,” says Dr Poudel. The condition is called andropause. Cases of it among men around or over 50 years of age is said to be quite common, but many remain oblivious to it. In Dr Poudel’s experience, many patients even tend to assume its symptoms to be results of psychological issues but clearly that’s not the case. He shares more about the condition with The Week.
What sort of cases makes you suspect that the cause may be andropause?
Most of the time, patients, i.e. men around 50 years of age or over, come to us with complaints of loss of libido, erectile dysfunction, depressive tendency, irritability or erratic mood swings. These are the really common cases. Some have also reported hot flushes but these are few and far between.
Even when the patients approach us, they are reluctant to share all the information. Either they consider it to be irrelevant associating the symptoms with old age or they are reluctant because they have serious concerns about their sexual ability. As doctors, often we have to put in extra effort to make them open up.
How do you explain andropause to your patients?
Basically symptoms of andropause are due to depleted testosterone levels. With age, both men and women experience an increase in the concentration of Sex Hormone Binding Globulin (SHBG) that in men is designed to bind with testosterone. So when SHBG increases, the sex hormone becomes unavailable for use. When you have less free testosterone, you notice the symptoms particularly in areas like the brain, phallic organs, bones, muscles, and ligaments where you have free testosterone receptors. For example, a patient will feel like their cognitive functions are decreasing, they are becoming more forgetful, they have less sexual desire, there is decrease in muscle mass and so on.
But they do sound like symptoms of old age. Is there a way to get official diagnosis?
It’s believed around 30 % men experience symptoms of andropause. But unlike menopause, where women almost immediately feel the symptoms of her ovary starting to stop production, in andropause, the symptoms don’t come in suddenly. A patient will experience it gradually. So indeed, it may feel like old age is getting the better of you. However, if your testosterone level is dropping much earlier than expected in life, with proper diagnosis and treatment you can help your body maintain it. There are tests that can check your testosterone as well as SHBG levels.
So there are ways to tackle andropause?
Yes, those who are aware of this condition and thus have had their tests as well as a diagnosis can chose to treat it. While reduction in hormone levels is a natural phenomenon, it’s not something you have to live it.
Ideally, before you reach andropause, if your tests are showing premature signs of a dip in testosterone, we recommend stress reduction, adequate sleep, regular exercise, meditation, healthy diet and such because a balanced lifestyle can help build your testosterone production. Obesity, for instance, is a big threat to it.
However, in cases where the drop has already been experienced you can choose supplements. Now these supplements aren’t like the ones consumed by athletes to improve their performances. Our aim is to only bring the hormone level back up to normal so we use bio-identical testosterone. The supplements are available in capsule and gel forms as well but, in our country, injections are more accessible. You can use them every two to four weeks. You will have to keep checking the levels. Once it’s back to normal, you can stop using them.
Does this mean you are slowing down the aging process to an extent as well?
Andropause can speed up the symptoms of old age in a man. You could only be in your 50s but already unable to quickly learn new things, memorize information, feel fatigued, depressed or experience a lot of decrease in your muscle strength, have low sex drive and, perhaps, even suffer from decreased bone density. By taking testosterone supplements and maintaining your hormone level, you can improve your condition on all these fronts. In some cases, we can maintain the testosterone level as well as their vitality up to 80 to 90 years as well. So, in a way, you could say we are slowing down the aging process.
How do patients react when you explain this male version of menopause to them?
People are really not aware of this condition. Sometimes it is hard to diagnose people because of it as well. Even when we do, it is hard to convince people because they say they have never heard of anything like this. It all comes down to spreading information. Just like the way everybody is aware of the thyroid complications and more are willing to talk about menopause, it is all about spreading the word. Testosterone level in men starts decreasing a little when they hit their 30’s, I’d recommend more to test their levels as they reach their 40’s.