40, moody, depressed and male? It may be andropause
Ryan Smith* always believed in the saying 'growing old is no more than a bad habit that a busy person has no time to form'. But on his 52nd birthday, when his office decided to have a party for him after work, the usually fun-loving advertising professional wanted to find a way to get out.
"I just didn't feel like going. I simply wanted to go home, curl up in bed with a book and just be on my own," says Ryan, who finally decided to visit his family physician when even at boardroom meetings he wanted an excuse to get out.
"I wasn't sure of myself anymore. There were these mood swings I went through, my work suffered and then I decided to seek professional help."
Like Ryan, 45-year-old Hosseinur Ali*, an art director, felt one day that his old drive was missing.
"My wife actually pointed out I was putting on weight, becoming sloppy and, more importantly, I was not interested in her. That was a serious allegation, and I decided to confide in friends before it wrecked my married life. Thankfully, they advised me to see a doctor. I was told it was andropause."
Symptoms
Andropause, associated with a decline in androgen levels, usually occurs in men in their late 40s and early 50s. It brings about mood swings, depression, low energy levels, low sex drive, increased upper and central body fat, weak bones and back pain and cardiovascular risk.
Unlike menopause, which generally occurs in women during their mid-40s to mid-50s, this phase in a man's life is much more gradual and can last for several decades. Andropause was first described in medical literature in the 1940s, but for a long time it was under-diagnosed and under-treated.
With men living longer now, there has been an increasing interest in andropause and its effect on a man's emotional well being, professional and family life.
Andropause is associated with low testosterone levels. In men, there is a decline in testosterone levels after 30. But since there is great variability in testosterone levels among men, not all men experience the same changes. Neither is the age predictable when symptoms will occur in a particular individual.
Long-term effects
"Men are often perplexed and confused when they are diagnosed with andropause. But it is much more accepted today, and men are more willing to undergo treatment," says Dr. Robert S. Tan of the Department of Family Practice and Community Medicine, University of Texas Health Sciences Center.
In his article, "Is it andropause? Recognising androgen deficiency in aging men," (Postgraduate Medicine Online) Dr. Tan writes: "Transitory symptoms of andropause include mood changes and changes in sexual function. Potential long-term effects include osteoporosis, muscle atrophy and cognitive changes.
"Primary care physicians are probably in the best position to evaluate the andropause syndrome in ageing patients. Some factors associated with andropause result from lifestyle habits or stress.
"Therefore, counselling may have a big role in the treatment of these patients. Exercise and weight training may even increase testosterone levels in older men. Physicians must be aware that testosterone levels are not static and that they change over time."
Says Dr Dawood Mohammad, Specialist-Urologist, Belhoul Speciality Hospital, "Most men come to us with complaints such as loss of libido, prostate enlargement or hair loss, which they feel are all part of ageing.
"The term andropause is still not so well understood. It is only when we explain the hormone imbalance in the body that men come to fully understand this phase.
"Unlike menopause, which can be collectively treated with oestrogen, andropause should be approached differently. If a person is suffering from depression, we treat it differently than we would in the case of a prostrate enlargement or the loss of libido.
"Also, in the case of high blood pressure, high blood sugar and liver or kidney disease it might not be right to undergo a testosterone replacement therapy," says Dr Mohammad.
Balanced diet
According to Dr Tan, not all endocrinologists and urologists are trained to manage andropause well. It is therefore advised to find a doctor who specialises in men's health.
Eating fewer carbohydrates and more fresh fruits and vegetables help men stay healthy. Also, zinc supplements are being investigated as means to maintain testosterone.
Moderate aerobic exercise combined with weight training for 20-30 minutes several times a week is also helpful. According to Dr. Derek Younge, it's never too late to exercise.
"Most of the time we start exercising in our twenties and by the time we hit our 40s, we get tired and let go. But it's never too late to start again.
"I started running when I was 40, and it has helped me deal with life in a better way. Exercise is a great mental booster, so those who do it regularly will cope well with depression and age-related problems."
There are several psychological issues that a man struggles with during andropause. His sexuality, his thoughts, his emotions, his confidence and his productivity are all challenged during this period.
"It is a time when the family has to be most supportive," says Dr. Mohammad Sameh Talib, Specialist - Psychiatrist at Belhoul Speciality Hospital.
Fear of loneliness
"Men suffer from insomnia and anxiety at this stage. They feel they are losing their masculinity and energy, and often remain depressed.
"In many cases, expatriates living away from their families face a greater degree of alienation. They come to us complaining of this fear of loneliness, but it is all a result of hormone imbalance."
According to Dr. Tan, the andropausal man fears treading uncharted waters. Alexander Prokhorov*, a 45-year-old IT professional living in Dubai, for instance, admits that although he was once a fan of adventure sports such as bungee jumping, he now prefers to sit at home and watch television during his holidays.
"Although I am physically fit, my mind is not interested in any outdoor activities. I've become slow, and even a harmless hike in the woods or a dune bashing weekend doesn't seem to interest me at all," he says, adding, "My family tries to be supportive, but I think I am a real spoilsport for them. I don't think I have the courage to try out something new at this stage."
Dr. Tan feels that it is best to address andropause as part of ageing. According to Dr. Nagwa Khalil Akasha, Speciality Physician and Endocrinologist at the Belhoul Speciality Hospital, men are hesitant to broach the topic.
"Men often don't like to discuss these problems and as a result they remain under-treated. But those patients who have received the testosterone replacement therapy under medical supervision have had positive results so far. They have regained their energy, and this has positively influenced their married and family lives."
(* Some names have been changed to protect identities)
