The Myth of the Male Menopause
By Dr. Terry Maguire, a Northern Irish Community Pharmacist, senior lecturer at School of Pharmacy (Queens University Belfast) and Belfast LCG member.
Debbie, a young trendy GP from Dublin, shared a speaking platform with me some months back in England and, afterwards over dinner, she told me that the big new thing in the Republic of Ireland was TRT; a sure-fire therapy for the flagging middle-aged male. She was being encouraged by her medical partners (males) to discuss with male patients the possibility that their; tiredness, low mood, general difficulties with life may not be just symptoms of a mid-life crisis; but may be symptoms of the male menopause. “If testosterone levels are sub-normal each man is a candidate for TRT – testosterone replacement therapy” she confided.
Feeling not just on top form that evening; and I must say looking pretty washed out too, I wondered if she was assessing me as a potential candidate so I asked her if the male menopause was not just a myth. I confessed that I saw a lot of myself in her description of the train-crash that is the male middle-age but I could not agree with a clinical male menopause. “Your right, its bollocks” she replied with forthright clarity “and a shame on my profession” she continued. “But the male menopause is merely a symptom of the financial down-turn”.
Bollocks it is according to the learned New England Journal of Medicine. A study into the safety and efficacy of TRT was stopped in 2009 on grounds of safety; a small matter of a four-fold increase in cardiac events and the appearance of that appalling phenomenon “man-boobs” plus increases in prostate cancer prevalence and breathing problems during sleep.
It is a myth confirms the British Medical Journal as only 0.1% of men over 40 years have low testosterone and this goes up to only 5% of men in their 70s. Yet the marketing men persist as we now live in a “Your-Only-Think-Your-Fine” culture so when you start gaining weight, have a noticeable reduction in energy and start to lose interest in (or performance during) sex then sensibly something is wrong and seeking a medical solution seems only rational. Yet according to BMJ the link to an age related reduction in testosterone levels and specific symptoms remains weak. Notwithstanding this there is a section of the medical fraternity that is committed to making all age-related phenomenon into diseases. And 13 million Americans cannot be wrong which is the number that have been converted to monthly TRT.
Until recently I had forgotten my evening discussions with Dr Debbie but I was sitting outside a well-know Belfast bar in the late summer when a friend of old with her new partner happened along. They joined us and, with a giggle, John, in his early 50s, was introduced as the “new boy friend”. As we finished the second cocktail John, getting more relaxed now, asked me if I had ever considered testosterone replacement therapy telling me it had done wonders for him.
I must have looked confused because he stood up from his chair, placed his palms on his flat stomach and slid them up to his shapely pectorals. “See that” he said conspiratorially, “that’s the benefit of testosterone replacement therapy”.
“Impressive” I mumbled yet my facial expression I suspect failed to confirm this sentiment because he told me that just after he turned fifty he awoke regularly without an erection and therefore had a sense something was seriously wrong. Having sold a successful business in England he is now retired and lives in Spain. When he presented his “serious erectile problem”, to his Spanish doctor, the physician suggested blood samples and surprise, surprise, found his testosterone to be sub-normal; he needed TRT.
On questioning John what a normal testosterone level was he replied it ranged from 225 to 1100 unsure if the units were; milli, micro, nano or pico grams (they are ng/dL). Anyway he was 219 ng/dL and as a result he now spends over Euro 150 a month on a testosterone gel which he applies (to his arm).
Was he not experiencing side-effects I asked concerned. None other than the fact that his testicles have reduced in size from “peach-stone size” to “pea size” and not even the marrow fat variety – we are talking sweet garden pea here. I looked shocked so he quickly continued that this is to be expected as the testes are the main glands for production of testosterone and, since it’s on a negative feedback system, when you have synthetic testosterone coming into the system, testicular production stops; thus the change in size. It had no impact on his hair which he claimed to be as bushy as it was when he was 18. He claimed to have read extensively on the topic and for this reason he also takes an anti-oestrogen to stop him developing “man-boobs”. He has never felt or been better and yes, each morning he awakes, he is impressed even more with himself.
I left his company feeling inadequate and inferior but when the cocktails wore off I decided it was after all just bollocks and it’s only one of the many ways the medics in bankrupt EU countries are employing to make ends meet.
