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Andropause: When Guys Get 'The Change'

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Note: Last month, I wrote a blog about foods for women in mid-life. After some -- heated -- commentary about my sexist approach to mid-life, I decided to cover the male aspect.

In 1944, researchers Carl Heller and Gordon Myers identified symptoms of what they termed "male climacteric," another word for menopause; these included loss of libido, depression, inability to concentrate, and sometimes hot flashes. The term "manopause" was later coined to describe the physical and emotional changes many men experience in their late 40s and early 50s. The popular media subsequently linked "manopause" to such 50-something male behaviors as buying a pricey sports car, changing careers, or hooking up with a younger woman.

While the phenomenon of a male menopause is debatable, the physical effect of reduced testosterone is very real. Testosterone is one of the primary male sex hormones, and it's crucial for the development of male reproductive tissues, building muscle, bone formation, normal sexual drive and stamina, and overall well-being. Starting around the age of 35, all men (and women) experience a gradual decline in the amount of testosterone their bodies produce; simultaneously, levels of sex-hormone-binding-globulin (SHBG) increase, further inhibiting testosterone.

By the time most men are in their 50s, testosterone levels are low enough to create a constellation of changes. This phenomenon is called "andropause," sometimes referred to as ADAM ("androgen deficiency in the aging male") or PADAM ("partial androgen deficiency in the aging male"). Some studies suggest that andropause is associated with increased risk of osteoporosis, heart disease, insulin resistance, and possibly Alzheimer's disease. More immediately noticeable effects of lower testosterone include weight gain, loss of libido, diminished mental acuity, reduced muscle bulk, depression, impaired memory and fatigue.

Not surprisingly, these changes dramatically affect a guy's emotional and spiritual well-being."Male menopause is a physical condition with psychological, interpersonal, social, and spiritual dimensions," says Jed Diamond, Ph.D., author of Male Menopause (Sourcebooks, 1998) and The Irritable Male Syndrome (Rodale Books, 2005). "Although this is a potent and multi-dimensional change of life, media often focus on the more superficial aspects of men leaving their older wives for a younger woman or changing careers." In Understanding Men's Passages (Ballantine Books, 1999), author Gail Sheehy says, "If menopause is the silent passage, male menopause is the unmentionable passage ... It strikes at the core of what it is to be a man ... his youthful sexual drive and performance."

Predictably enough, there's some controversy. Some say andropause is real, but "manopause" is a myth perpetuated by authors and companies to promote services and products designed to address the so-called male menopause. While few would argue that men lose testosterone as they age, it's an entirely different situation than menopause, some say, and has little to do with any perceived emotional or spiritual events. Unlike menopause, during which a woman's hormones decline suddenly and precipitously, the loss of testosterone is slow and gradual enough that most men don't notice the corresponding subtle changes. Say the authors of one study, "The extent to which an age-dependent decline in androgen levels leads to health problems that might affect or alter the quality of life remains under debate."

Whether andropause is a man's version of menopause replete with emotional, psychological and spiritual changes, or just a blip on the hormonal screen, may depend on your own circumstances and makeup. But if you're a guy (or you have a guy) who's experiencing some mid-life shakeups, some things you might consider:

• Testosterone replacement therapy (also called TRT) can balance and replace testosterone levels and decrease the symptoms of andropause. Unlike estrogen or progesterone therapies, "pharmaceutical, prescription forms of testosterone, especially topical and pellet forms, are for the most part bio-identical," says Jennifer Landa, M.D., chief medical officer of BodyLogicMD in Orlando, Florida. "Even the injectable forms are very similar to bio identical." TRT can have side effects, and should be thoroughly discussed with your health care provider, especially if you're at risk for prostate cancer. Some natural supplements -- Tongkat ali, Tribulus terrestris, zinc, horny goat weed -- have shown promise too in easing symptoms of andropause.

• Watch your weight. Testosterone can be converted to estrogen via an enzyme called aromatase. "Some men are genetically predisposed to more aromatase activity," says Landa, "but being heavy also has an impact, since aromatase is present to large degree in fat." And fat begets fat. "Lower testosterone as a result of aging means more muscle converts to fat," she says. "Then, having more fat means more testosterone is converted to estrogen. It's a really negative cycle of events."

• Avoid estrogenic compounds. As testosterone levels naturally decrease with age, the ratio of testosterone to estrogen in a man's body falls. When men are exposed to additional sources of estrogen, it further upsets the balance of testosterone to estrogen. Endocrine disruptors and xenoestrogens from plastic food wraps, personal care products and conventionally raised meat and dairy are the most common sources. "These are just as important for men to avoid as for women, especially since they also increase the risk of prostate cancer," says Landa. To minimize exposure, choose organic, grass-fed or pastured animal products, avoid plastic food containers, and buy natural personal care products that are free of parabens and other chemicals.

• Recognize the spiritual side. "During this stage, men have to look at all aspects of their lives, including the spiritual," says Diamond. "They may question old patterns and wonder, 'Now that I've done what I was supposed to do, what do I really want to do with my life while I still have time?' Many men have spent a lifetime on a career. Now they want to explore their calling, the deeper more spiritual aspect of what they do." Give yourself ample time and space to recognize these changes -- and be willing to go with deeper callings.

For more by Lisa Turner, click here.

For more on aging gracefully, click here.