Written by Carolyn Poirot

July 2007 | Star-Telegram.com

Irritability. Trouble sleeping. Decreased bone density. Some doctors say that when it comes to midlife hormonal changes, women aren’t the only ones who suffer. Here’s what you need to know about.

Call it andropause, male menopause, or even manopause. It’s an idea that’s getting increasing attention in the medical community as a way to describe the physical changes a man goes through in midlife. Some doctors suggest that the answer is hormone replacement therapy, along with changes in diet and exercise.

Others caution that anti-aging treatments may have questionable value.

We answer 10 burning questions about manopause.

What is manopause?

Andropause, or manopause, is the male version of menopause. The big difference, of course, is that menopause signals the end of a woman’s ability to conceive. The male reproductive system doesn’t shut down. But men have midlife physical changes, too, caused by a decrease in male hormones, especially testosterone. Testosterone production peaks at about age 19, and after age 30 declines at the rate of 1 percent to 2 percent per year.

Why haven’t I heard of this before?

The term “male menopause” was used in a 1944 study published in the Journal of the American Medical Association, but the term didn’t really come into public use in the U.S. until 1998 with the publication of Dr. Eugene Shipman’s Testosterone Syndrome. Television personality Suzanne Somers popularized the word manopause in her book The Sexy Years two years ago. Her new book, Ageless: The Naked Truth About Bioidentical Hormones, which also discusses the concept, was published last fall.

What are the symptoms?

The top 10 signs are irritability, sleep problems, diminished libido, erectile problems, muscle loss, weight gain, memory loss, thinning hair, decreased bone density and depression.

And how is that different from normal aging?

Many physicians consider the drop in hormone levels a normal part of aging. However if blood tests show significantly low levels of testosterone and if symptoms are present, andropause may be diagnosed and treated in men at any age.

Are there any manopause specialists?

Internal medicine, endocrinology and urology are the main medical specialties that deal with andropause. The American Academy of Anti-Aging Medicine offers fellowship training in the specialty, which is not recognized by the American Medical Association.

One network of physicians, called BodyLogicMD, was founded in 2003 and specializes in bioidentical hormone therapy integrated with fitness and nutrition programs for men and women suffering from the effects of hormonal imbalance, menopause and andropause. The group has 16 physicians in nine states, including Dr. Susan Linder, a pain management and rehabilitation specialist in Fort Worth. She is the only BodyLogicMD doctor in Texas.

Linder says getting a grip on andropause is a matter of balancing hormones, reducing stress, increasing exercise and eating small, nutritious meals every three or four hours. Extensive patient histories and blood work are used to determine how much of which hormones each patient needs, and follow-up tests keep track of how much is getting into the bloodstream.

“Testosterone has become the hormone of the day, but we also use bioidentical estrogen, progestin, human growth hormone, DHEA, thyroid hormone and other combinations depending on the symptoms and what laboratory tests show,” Linder says.

Bioidentical hormones are man-made in the lab from soy and yams, but their molecular structure exactly matches hormones made by the human body.

What do treated patients say?

We spoke with two of Linder’s patients, who asked that we not give their last names to protect their privacy.

Two months ago at “almost 65,” Jarold, an oil and gas operator in Fort Worth, was so tired and overweight, he began to fear he would have to give up his weekly golf games.

Blood tests showed that Jarold was “extremely low” on both thyroid and testosterone despite being on thyroid treatment for 11 years.

“I started using a prescription cream compounded specifically for me by a mail-order pharmacy, and I could tell a huge difference right away,” he says. “I haven’t lost much weight yet, but at least I have the energy to exercise.”

Carl, another patient, says he had nine of the 10 symptoms of andropause.

“The only thing I didn’t have was [decreased bone density],” says Carl, 58, who lives in Dallas and is fulltime caregiver for his father who has Alzheimer’s.

“I was exhausted all the time. Dr. Linder put me on bioidentical testosterone and a low-glycemic diet — lots of fruits, vegetables, lean beef, chicken, fish and legumes — and now my energy level is sky-high. I lost 12 pounds the first month.”

But what does the established medical community think about testosterone replacement?

Dr. Robert Butler, founding director of the National Institute on Aging and president of the International Longevity Center, a nonprofit affiliate of Mount Sinai School of Medicine in New York, called for a Men’s Health Initiative to determine the true effects of testosterone replacement therapy in 2003.

Butler said last week that budget restraints on the National Institutes of Health have bogged down the initiative, long-term research has not been done, and there is no established medical specialty board to certify physicians dealing with testosterone replacement therapy.

“All hormones have side effects, which are not always advantageous,” Butler said. “Anti-aging medicine is a big industry, and anti-aging treatments have questionable value. It’s very important to be adequately tested. Many older men still have normal testosterone for their age and do not need supplements. We need to realize nature may have a reason for the decline of some of these hormones. It sounds like a good idea to replace them, but that hasn’t been proven adequately.”

Are there any risks associated with testosterone replacement or bioidentical hormones?

While the possibility of testosterone supplements increasing the risk of prostate cancer has caused concern in the past, a comprehensive review of 72 studies, published in January 2004 in the New England Journal of Medicine, found “no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer or cardiovascular disease” even though the hormone does contribute to the growth of tumors already developing.

No risks have been reported for bioidentical hormones, which soared in popularity after the Women’s Health Study reported in 2002 that the most popular form of synthetic estrogen might increase the risk of breast cancer and heart attacks, especially in the oldest women studied.

What does treatment cost and will insurance cover it?

BodyLogicMD physicians do not file insurance claims but help patients to do so on their own, and diagnosis and treatment are often covered, Linder says. Her initial consultation with extensive patient history costs $375, and blood work runs $625.

Most internal medicine doctors, endocrinologists and urologists will prescribe testosterone supplements when needed. Many file insurance claims for their patients.

Scott Lawson, compounding pharmacist at Perrone Pharmacy in Fort Worth, said he knows of no readymade testosterone pills, but testosterone replacement is available by prescription at compounding pharmacies, including his. The most common dosage of the gel and cream costs $30 to $40 for a month’s supply and is usually covered by insurance, Lawson said. He also compounds testosterone capsules. Testosterone skin patches and pellets (that are inserted under the skin) are also available.

If I think I’m suffering from male menopause, what should I do?

Talk to your primary-care physician. He or she may order blood tests to help determine whether hormone replacement therapy is right for you. Hormones are available by prescription only.

More information On the Web:

National Institute on Aging at www.nia.nih.gov; click “publications,” then “men’s health,” then “Pills, Patches & Shots: Can Hormones Prevent Aging?”

BodyLogicMD Books:

The Sexy Years and Ageless, by Suzanne Somers; Testosterone Syndrome, by Dr. Eugene Shipman; Maximizing Manhood, by Dr. Malcolm Carruthers

Possible treatments

• Increase weight-bearing exercise
• Lose weight
• Eat healthier but smaller meals
• Take calcium supplements
• Try hormone replacement therapy

Carolyn Poirot, 817-390-7687