By Francesca Sullivan
Is there such a thing as male menopause? This is a question still being debated amongst the medical community, though for some men going through middle-age, the answer might seem clear. Although the symptoms may not be as recognizable as those of women, a proportion of men over the age of fifty begin to experience declining energy levels, mood changes, lack of concentration, sexual problems and depression, which andrologists link to the lowering of testosterone.
Although some would argue that these problems are simply a result of unhealthy ageing (leading a lifestyle that includes lack of exercise, bad diet, weight gain, over use of alcohol or drugs, and the onset of conditions such as diabetes and hypertension), some doctors will prescribe controversial testosterone treatment to improve quality of life, and sexual function in particular.
Male hormone replacement therapy is gaining ground, especially in the US, where drug companies are allowed to push the issue with aggressive marketing direct to the public. But is it advisable or even safe? And are there other forms of therapy that can address such ageing issues?
Cairo West Magazine spoke with Professor Hussein Ghanem, professor at Cairo University Faculty of Medicine. An andrologist and a dermatologist specializing in non-surgical aesthetic procedures, Prof. Ghanem tells us how male menopause is being recognized and treated in Egypt.
CWM: Are many people aware of the existence of male menopause?
HG: Very few. The signs are less easy to recognize, and come on more gradually than in female menopause. From the age of forty there is an annual decrease of 1% in testosterone levels in men, so the effects often don’t really start to appear until the fifties and sixties. And usually when signs do crop up, they can be misleading. Men will start to seek help for different symptoms individually without realizing that there’s a link between them.
What are the first indications a man should look out for?
Physical changes range from decreased energy and general weakness and fatigue, to loss of libido and sexual function. Psychological and emotional changes may include unexplained anxiety and depression.
Are men generally open about this issue?
In my experience, men are willing to discuss it with a doctor that they trust. In general, men tend to pay less attention to health issues than women though. Men continue to live on average seven years less than women, and women pay better attention to health issues. For example, statistically they visit the doctor 150% more often than men, and while 17% of women do regular breast examinations, only 1.2 % of men have their PSA measured. With the global increase in life expectancy, it makes sense to pay better attention not only to the length of your life but also its quality.
Are there supplements or medications that can alleviate symptoms?
There are no supplements proven to be effective in this area. And testosterone must be taken under medical supervision. Although the subject is still being fiercely debated, there is some evidence to suggest that men at risk from prostate cancer will increase that risk with hormone replacement therapy. Before offering hormone treatment we would run tests for total testosterone levels as well as PSA over a period of several months.
It is important to look for lifestyle solutions such as giving up smoking, reducing stress, losing weight and getting more sleep. Lack of sleep is proven to dramatically reduce testosterone levels, while weight loss can improve those levels considerably.
Psychologically, there are other confidence boosting strategies men can consider, such as aesthetic procedures to look younger. The age at which some men start experiencing menopausal symptoms tends to be around the same age as patients who come seeking aesthetic non-surgical procedures, and undoubtedly such procedures have been shown to have positive psychological effects.
Which kind of procedures are you referring to?
Botox, dermal fillers, fractional C02 laser therapy, PRP and thread lifts, are some examples. Although women make up a larger proportion of patients seeking these procedures, the numbers of men recognizing the positive potential of image enhancement is growing in Egypt. And it is especially relevant for those feeling the emotional effects of menopause. In my clinic I do not automatically suggest it to all patients, but I provide the relevant information to those I think would benefit psychologically.
Prof. Hussein Ghanem is a Professor at Cairo University and Consultant Dermatologist and Andrologist practising Anti-Aging & Esthetic Medicine at Dermahealth clinic in Cairo.