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Andropause: The male version of menopause

Medical practitioners describe andropause in ageing men as a time of weight gain, reduced morale and libido and perplexing behaviour, finds out Ornella D'Souza

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It's likely you've known an ageing uncle, neighbour or a colleague who, overnight, seems to have become "young at heart" by making drastic changes to his way of life — donning colourful shirts, listening to the latest teenybopper numbers, growing a pot belly, sporting a receding hairline, perhaps showing a disinterest in his spouse as well. While it may all seem baffling and be dismissed as a mid-life crisis, experts link this to andropause — Androgen Deficiency of the Ageing Male (ADAM). Think of it as the male experience of menopause.

"Such men cling to their youth the way a drowning person will hang on for dear life," explains Dr Amrapali Patil, founder of Trim N Tone obesity centre at Powai, Mumbai. Calling it "a psychologically delicate phase," she talks of a 55-year-old patient who wore tight speedo shorts to his granddaughter's parent-teacher meeting and told off his wife when she disapproved of his attire. "I came to know of this incident almost by accident, and that's when I realised that he was also experiencing andropause," says Dr Patil. "I recommended yoga and Ayurvedic medicines in addition to what we call Neuro-Linguistic Programming, which combines communication, personal development and psychotherapy."

Andropause is linked to decreased male hormones testosterone and dehydroepiandrosterone (DHEA) in the body. The production of testosterone in men after they turn 30 drops by one per cent every year, or about 10 per cent every decade, according to a 2011 report by the US-based Mayo Clinic. By the time men are in their late 30s-early 40s, they experience changes in their body and psychological make up. Some men may also experience premature andropause if their body produces more female hormone, estrogen. "Like yin and yang or purusha and prakruti, testosterone and estrogen must be in a balanced ratio, with higher testosterone production in men," says Dr Patil. An imbalance leads to weaker libido, erectile dysfunction, low tolerance to stress, crankiness, fatigue, decreased muscle mass and strength, impaired memory and concentration, insomnia, anxiety, depression, sweating and even hot flashes.

The jury is still out on whether to qualify andropause as a phase or a medical condition. "Andropause is a colloquial term in medicine. But most doctors use the term frequently," says nutritionist Dr Patil. So far, the World Health Organisation (WHO) does not recognise andropause as a medical condition. The reason: In women, menopause brings fertility to a halt. This is not the case when men experience andropause. "A 60-year-old man can still impregnate a woman, unless vasectomised," she says.

Cause for pause

Medical practitioners largely hold that andropause hits men in thier 40s, but because of lifestyle changes, even 30-year-olds today experience it. Citing lack of physical activity, excessive alcohol consumption and passive smoking as promoting factors, anti-ageing specialist Dr Seema Saadhika points out that as we age, the body's capacity to store fat increases, which in turn boosts estrogen. "Hence, men develop what are referred to as 'moobs' at this time," says Dr Saadhika.

As in most lifestyle conditions, stress is the chief reason why testosterone production decreases in the body, with the stress hormone cortisol disrupting the reproductive system. Dr Saadhika warns that men in the pharmaceutical industry, those who handle incinerators at plastics factories or pesticides on farms are particularly prone to experiencing andropause as they are exposed to parabens and chemicals — both of which boost estrogen levels in the body.

Test, and talk it out 

A simple blood test can indicate whether testosterone levels are in the normal range, usually between 300-1,200 nanograms per deciliter (ng/dL). "If testosterone levels are under 300ng/dl, an endocrinologist can decide the best course of action, either hormonal injections or transdermal patches on the scrotum," says sexologist Dr Uttam Dave.

But men seldom open up about andropause as it is viewed as an intimate subject, feels Dr Saadhika. "They beat around the bush about their low libido. On checking their eating habits, stress levels, hormones, zinc levels, vitamins intake and even overall appearance, it's easy to figure the cause," she says. "I invariably end up telling patients that I'm treating them for better nutrition. And it is only after being on a three-four week of a diet and exercise regimen that they open up about feeling a renewed urge for sex."

What's worse, says Dr Dave, is when men look for solutions on their own, blindly reaching out for Viagra, lapping up Google search results or following the advice of the friendly neighbourhood chemist. "Instead, men should look for authentic sources. Reading books by doctors on sexual medicine would help," suggests Dr Dave, who feels the concept of masculinity in India is ill-defined as they equate their inability to perform as a loss of their manliness. "A 70-year-old shouldn't compare his performance in bed to the time when he was 25. As you age, sex becomes more about companionship, more about foreplay and less about penetration — unlike the wild romps of youth. Telling your wife about your day at work makes you as much a man."

With low libido comes high ego, and men tend to shift the blame onto their spouse. "Quite a few of my patients have complained that their wives have no interest in sex or are not lubricated properly... the blame is often pinned upon the woman," says Dr Saadhika. Such lack of awareness makes this a difficult period for couples even though it need not be that way, points out Dr Dave. "The spouse can become a source of support if she is confided in, instead of the man fighting a lone battle. If he's shy, she should take the initiative to see a doctor," he says.

Get back on top

Counselling can help andropausal men get over their brooding and depression, but nothing works better than a healthy diet and ample exercise. Dr Dave lists lean meat, nuts and seeds, vegetables, fruits and whole grains. In addition, he prescribes oysters and herbs including withania somnifera (ashwagandha), tribulus terrestris (gokshura), asphaltum (shilajit) and asparagus racemosus (shatvari) for zinc, which increases testosterone production. Any form of exercise helps. "Even doing surya namaskara generates energy and improves blood flow to the genitals for improved sexual performance," says Dr Dave.

Dr Patil cautions about using plastic containers and polythene wraps for food as these contain parabens and artificial or xeno estrogen. "Processed foods like red meat, frozen foods and cold cuts disrupt the testosterone-estrogen balance. Green leafy vegetables boost testosterone," she says. "One has to come to terms with ageing. Push yourself, especially after 50, to exercise and watch your weight. Some come out as better people once they alter their lifestyle."

Toys for old boys

Raj Nayak, founder of sex toys e-tailer IMBesharam.com, says andropausal men and their partners can experiment with quirky, innovative sex toys for masturbation and oral sex. He cites examples: a rechargeable toy with silicone 'tongues' that rotate to 'lick' the penis in a frenzy, an artificial vaginal set-up inbuilt with a vacuum pump, elastomer shapes and a rotating orb for multiple sensations, non-porous stimulators with angled stems and bulbous heads for aggressive prostate and perineum massages. "Such products aim to tantalise the mind because andropause first attacks the mind," says Nayak. "Since sex is 90 per cent in the mind, andropause impacts sex."

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