It’s a classic medical stand-off with two sides completely entrenched in their beliefs and raucously pointing to the same data as proof of their own case.
The argument seems very straightforward; is the male menopause a myth or a reality?
The theory is a simple one; as men get older their testosterone levels drop producing symptoms of evolving body chemistry adjacent to, but not the same as, women undergoing menopause.
These symptoms include; a decline in general well-being, joint and muscular pain, excessive sweating, sleep problems, lethargy, irritability, anxiety, reduced muscular strength, depression, feelings of inadequacy and failure, slower hair growth, reduced libido, sexual dysfunction.
Proponents of the theory stress that in most cases these symptoms are mild and change subtly over time which is why most men simply accept them as part of the ageing process.
Opponents say that is precisely the point; all of these indicators can be attributed to age, but the acute and radical shifts in a woman’s physiological balance which result in much more pronounced and debilitating symptoms merit their classification as a medical phenomenon.
The transition of a young man into middle age, they argue, is not in the same league and certainly not worthy of the name.
Until now the opponents of the menopause (also known as the ‘andropause’) have been able to point to the lack of evidence of widespread testosterone loss in the male population as proof positive that the condition is a purely theoretical construct.
That is until the publication this week (July 28) of the results of a 25 year study into the identification and treatment of Testosterone Deficiency.
Published in the journal ‘The ageing Male’ the study uses the records of over 2000 patients treated at the Centre for Men’s Health in London’s Harley Street.
The paper argues that up until now the testing for testosterone deficiency has been flawed by comparing an individual’s testosterone levels with those of males of a similar age.
Because of the general decline in testosterone in the male population this will always tend towards ‘normalising’ the individual’s level and masking any significant reduction over time.
If they were compared to those of healthy younger males a more marked deterioration would be highlighted and identified for treatment, specifically Testosterone Replacement Treatment.
The paper is really a vindication of the methodology and treatment that this £300 an hour private clinic has been practising for decades.
Without wishing to question the good intentions of the research or the conclusions drawn by its main author, Professor Malcolm Carruthers, that a large proportion of men would benefit from TRT if only doctors tested for it properly, we'd have to point out that he would say that wouldn’t he?
After all, under current medical guidelines no health insurer would pay out for the expensive treatment that Professor Carruthers and his colleagues offer at their high-end clinic.
A wider recognition of their methods and diagnosis could eventually bring an official approval and even a change in policy that would provide more opportunities to swell their coffers apart from the acclamation of the Centre as a worldwide leader in the condition.
It doesn’t mean we should dismiss the report, just that we should treat its provenance with care.
Does it prove that the manopause exists?
In a word, no.
It does confirm the gradual decline in testosterone levels but does not link this directly to any adverse symptoms in the patient.
Nor does it conclusively prove that TRT would alleviate any of the more pernicious effects.
As men get older they get lethargic and grumpy, they often feel unfulfilled and depressed at the fact that the best has been and gone; that’s life.
Clearly there are those who need TRT, but it is hard to agree to the 20% of the male population figure that Dr Carruthers estimates.
Nor is there any comparison to the hardships endured by women who would not only have to deal with their own menopause, but the bleating and whining of their manopausal partners.
I think we all need more proof before we allow that to happen.
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