Manopause and Low T: Two Issues Whose Time Has Come

By Jed Diamond, PhD, LCSW

The August 18, 2014 issue of Time magazine had a cover story lead article titled: “Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry.” I joined a number of other men’s health experts on Huffington Post Live to discuss the article and its implications. The article begins with a provocative statement and a question. “These drugs promise to pump up men who feel deflated. But are they safe?” I had the same question when I began doing research on the male “change of life” a.k.a. Male Menopause or Andropause in 1994. But I also had other questions. Is there a male change of life? Is it similar or different from what women experience as menopause? How do these changes fit in with the overall picture of men’s health? What’s the best way to help men stay healthy throughout their lives?

My research, still in progress, has culminated thus far in a series of books on “Manopause and Men’s Health,” including Male Menopause ( Rodale, 1997), Surviving Male Menopause: A Guide for Women and Men (Rodale, 2000), The Whole Man Program: Reinvigorating Your Body, Mind, and Spirit after 40 (Wiley, 2002), The Irritable Male Syndrome: Understanding & Managing the 4 Key Causes of Depression and Aggression (Rodale, 2004), and Stress Relief for Men: How to Use the Revolutionary Tools of Energy Healing to Live Well (North Atlantic Books, 2014).

Based on my research and work with men and their families for more than forty years I’ve found some answers to my questions:

• If used properly testosterone is safe for men. (Though risks and benefits always have to be weighed when considering any treatments.)
• There is a “male change of life” that occurs between the ages of 40 and 55 for most men.
• There are more similarities than differences between Menopause in women and Andropause (“Manopause”) in men
• For the best overall health we need to pay attention to physiological, hormonal, psychological, interpersonal, sexual, social, economic, environmental, and spiritual changes in the lives of men and the people who love them.
• For complete health for men we need to focus on stress relief, aggression and depression prevention, weight loss, exercise, increased emotional intimacy, positive social connections, hope, purpose, and a healthier and more sustainable relationship to the Earth.

A Short History of Testosterone’s Rise and Fall in the U.S.

According to medical historian Elizabeth Watkins, the idea of male menopause is not new. In an article titled “The Medicalization of Male Menopause in America,” she says, “it had been discussed in both medical and popular literature since the 1930s.” Two events brought testosterone to the attention of the medical community and the public. The first was the publication of a research study by Carl G. Heller, MD, PhD and Gordon B. Myers, MD and published on October 21, 1944 in the Journal of the American Medical Association.

The research study begins with an overview of the issue: “During the past few years several articles have been published in medical journals about a syndrome occurring in middle aged men which has been termed the male climacteric. The syndrome has been characterized principally by nervousness, psychic depression, impaired memory, the inability to concentrate, easy fatigability, insomnia, hot flashes, periodic sweating and loss of sexual vigor. The chief basis for the diagnosis of male climacteric in published reports has been the similarity of the symptoms to those of the female menopause and the relief sometimes afforded by androgenic therapy. The claim has been made that most men and all women pass through the climacteric during the fifth decade and that the diagnosis of male climacteric is frequently missed.”

It was a small study, but symptoms improved after giving the men injections of testosterone. Heller and Myers concluded, “Definite improvement in the symptomatology was noted by the end of the second week in all of the twenty cases treated.” They also noted that testosterone helped restore potency as well as libido.

The second event that brought attention to testosterone treatment was the 1945 publication of The Male Hormone by microbiologist and author Paul De Kruif (I have a little green copy of the book that was given to me many years ago with the cover price of 35 cents). De Kruif is most noted for his 1926 book, Microbe Hunters. The book was not only a bestseller for a lengthy period after publication, it has remained high on lists of recommended reading for science and has been an inspiration for many aspiring physicians and scientists.
When De Kruif began his research for The Male Hormone, he was fifty years old and looking for something that would address his concerns about aging. “Though it may not be possible to throw advancing age into reverse,” he said, “yet there might be a gleam of chemical promise of prolonging what was left of my prime of life.” Based on what he learned from the medical authorities of the time he felt that testosterone might be helpful.

After considerable study De Kruif wrote the following: “The male hormone discloses magic far beyond the merely sexual. It boosts muscle power. It banishes mental fatigue. It eases heart pain. It even restores the sanity of men in middle life who suffer from physical deficiencies.”

With a positive research study in one of the most prestigious medical journals in America and an even more positive popular book by a well-respected science writer, we might think that testosterone treatment would take off and become a cornerstone of men’s health care in the U.S. But that’s not what happened. The medical historian Elizabeth Watkins found that “The topic of male menopause occupied space on the medical radar screen from the late 1930s through the mid-1950s, then virtually disappeared for the next four decades, until the late 1990s.”

In doing research for my book, Male Menopause, I found that though the focus on testosterone treatment disappeared in the U.S., it was embraced in other parts of the world. Beginning in the 1950s a Danish physician, Jens Moller, began treating older men with testosterone. Not only did it help with emotional and sexual problems, it also helped with severe circulatory problems. Though often in conflict with the conservative medical establishment in Denmark, he treated patients until his death in 1989. Dr. Moller’s work is being continued by Dr. Michael Hansen in Denmark and Dr. Malcolm Carruthers in England.

Dr. Carruthers, is a Consultant Andrologist with over 35 years of experience in the field of testosterone treatment and men’s health. He has treated more than 2,500 men with testosterone. He has written numerous books including The Testosterone Revolution and Androgen Deficiency in the Adult Male.

Manopause and Men’s Health in the U.S.

Ken Goldberg, MD, is a board-certified urologist who founded the Male Health Center in 1989. It was the first clinic in the U.S. dedicated to treating the range of conditions specific to men. The Male Health Center also helped men live longer and better and helped them become more involved in their health. Goldberg wrote two excellent books on men’s health, How Men Can Live as Long as Women and When the Man You Love Won’t Take Care of His Health.

Although the Male Health Center went on for a number of years, it never captured major attention. A few others attempted to focus on men’s health, but the trend in the U.S. has been towards individual men helping themselves and working with health-care providers to improve important issues such as sexual dysfunction, addictions, depression, fatigue, anger, and chronic pain.

However, in the last ten to fifteen years, there has been an increased focus on using testosterone to treat health problems that men face. According to John LaPuma, MD, “The number of testosterone prescriptions given to American men has tripled since 2001. Three million prescriptions were written in 2012 for the market leader AndroGel alone. Sales of all testosterone-boosting drugs are estimated to have been $2 billion in 2012, and are projected to hit $5 billion by 2017.”

Throughout the country clinics are emerging that focus on men’s declining testosterone levels. One that is capturing attention, and was featured in the Time magazine article, is the Low-T Center. Founded by businessman Mike Sisk in 2009, the Center’s single goal is to “exclusively diagnose and treat men with low testosterone.” Sisk says, “We believe every man deserves to feel virile, have abundant energy, and experience better moods. Our mantra is ‘Getting older does not have to feel like it!’”

Not everyone feels that this single focus is the best way to improve men’s health. Bradley Anawalt, MD, is one of those doctors. He heads the Hormone Health Network, part of the professional association for endocrinologists that has released clinical guidelines for testosterone therapy. Anawalt calls the low-T clinics “sex hormone factories” that promote all the potential virtues and great myths about how testosterone may solve all problems. “They’re really out to prescribe as much testosterone as they possibly can, and it’s not clear that all these practices are completely safe,” he says.

The Future of Men’s Health and Gender Medicine

I feel that men’s health is a field whose time has come. We’re recognizing that although men and women share certain health issues, there are important differences. According to Marianne J. Legato, MD, founder of the Partnership for Gender-Specific Medicine, “Everywhere we look, the two sexes are startlingly and unexpectedly different not only in their internal function but in the way they experience illness.”

These differences can have an important impact on our health and well-being. According to David C. Page, M.D., professor of biology at the Massachusetts Institute of Technology (MIT), “We’ve had a unisex vision of the human genome,” says Dr. Page. “Men and women are not equal in our genome and men and women are not equal in the face of disease.”

Dr. Page concludes, “We need to build a better tool kit for researchers that is XX and XY informed rather than our current gender neutral stance. We need a tool kit that recognizes the fundamental difference on a cellular, organ, system, and person level between XY and XX. I believe that if we do this, we will arrive at a fundamentally new paradigm for understanding and treating human disease.”

I believe we are on the threshold of a health revolution that can empower men and women towards greatly improved health and well-being. My hope is that the clinics now offering testosterone treatment can expand their focus to help men with stress, aggression and depression, weight loss, exercise, emotional intimacy, positive social connections, purpose, and a healthier, more sustainable relationship to the Earth. I also hope that all health-care practitioners will learn about testosterone and how hormonal health can be an important aspect of total health for men and their families.

Jed Diamond, PhD, LCSW, is the Founder and Director of the MenAlive, a health program that helps men live well throughout their lives. Though focused on men’s health, MenAlive is also for women who care about the health of the men in their lives. Diamond’s new book Stress Relief for Men: How to Use the Revolutionary Tools of Energy Healing to Live Well