A few months ago, a 72-year-old judge walked into Dr. Damon Raskin's Pacific Palisades California internal medicine office with a problem he could barely articulate. The judge, well-known in his community, was fatigued all the time and had lost his passion for life. With a simple blood test, Raskin was able to figure out something else the man had lost: testosterone.
Low testosterone levels were zapping the judge's zest for living, diminishing his sex drive, reducing the results of gym workouts and even causing him to lose the sharp focus he held for his life's work. But he was one of the lucky ones. He knew things didn't have to be this way just because he was 72 and he sought help.
After using a testosterone gel for two weeks, the judge called Raskin and reported he had renewed intimate relations with his wife of 40-plus years, was feeling more like his old self and had basically found his mojo. Huff/Post50 caught up with Raskin, an expert on the subject, to talk about the problem that is popularly known as male menopause. Raskin is the supervising doctor for Ageless Men’s Health, a nationwide facility dealing with men’s health and anti-aging issues.
HP: How common is male menopause?
Raskin: Over the last five to seven years, we are seeing many more patients with male menopause. I think, to some degree, the problem has always existed but now men are starting to come forward realizing that low testosterone levels impact their lives adversely and that needn't be the case.
HP: Any hard numbers?
Raskin: The leading research on the problem of male menopause is the Hypogonadism in Males study, known as the HIM Study. It found that 38 percent of the men over 45 tested by their doctors have low testosterone. And that doesn't count the men who aren't presenting themselves in medical offices seeking care. I believe it is an underdiagnosed condition and is way more prevalent than we think.
HP: But just like female menopause, isn't this just a fact of biology? You get older, systems fail kind of thing?
Raskin: Female menopause is very different for a number of reasons. For one, we have points that help us define what's going on -- perimenopause, menopause, post-menopause. We use markers that are very obvious to denote where a woman is, when her menstrual cycle stops, when she experiences hot flashes, when she notices a diminished libido. With men, there are no milestones like that. Men's bodies are changing, but many of them don't understand that it could be because of hypogonadism -- lowered testosterone levels.
HP: What are the symptoms that typically bring a patient to see you?
Raskin: Interestingly, it isn't only lowered sex drive although that's certainly one of them. Often, they just feel almost depressed, not like their old selves, they don't want to do the things that used to bring them pleasure. They have lost their zest for life. Yes, in some cases, there is also erectile dysfunction and diminished sex drive.
HP: So, it's the husband telling the wife that he "has a headache?"
Raskin: Yes, and he worries about why he's not in the mood anymore. Sometimes it feels like general fatigue and there may be other conditions going on that we need to rule out.
HP: Like what?
Raskin: Underactive thyroid, anemia, their body composition is changing and they have more belly fat. They are working out but not seeing the results.
HP: So is this something that is confined to older men, guys in their 60s or 70s?
Raskin: Absolutely not. There are men in their 80s who don't experience lower testosterone levels and men in their 40s who do. Men with Type 2 diabetes are more prone to low testosterone. So are men with high blood pressure and men taking certain medications. Opiate use can lower testosterone. Men who have used -- abused -- steroids in the pursuit of athletics are also prone to it when the steroid use is stopped. Obesity has also been linked to low testosterone.
HP: What's the diagnostic process and treatment like?
Raskin: We run a screening blood test and testosterone levels are low, we screen to see what other causes might be present. If those are ruled out, the testosterone replacement therapy is fairly simple. It can be a patch, a gel -- that's the most common -- or even shots. These are all prescription medications.
HP: And that's it?
Raskin: No, there are follow ups to make sure the levels don't get too high. If testosterone levels are high, it can cause some irritability and aggressiveness. There are some potential links to prostate cancer, although no long-term studies have been done linking testosterone replacement therapy with prostate cancer. In some cases, a woman might complain that before the therapy, her husband wasn't interested in having sex ... and now she says he wants to have it all the time. There are side effects.