Although men have experienced symptoms suggestive of the female 'change' for years, most doctors have attributed those to the natural aging process. Could aging men benefit from testosterone replacement?

The concept of a "male menopause" and the need for hormone replacement therapy as a treatment is still highly controversial. Andrew Dott, MD, and Anthony Karpas, MD, of the Institute of Endocrinology and Reproductive Medicine in Atlanta, contend that about 40% of 40-something men experience these symptoms to some degree:

Only about 13% of men with symptoms have a low total testosterone level.

* lethargy, or fatigue
* depression
* increased irritability
* mood swings
* loss of bone density
* decrease in lean muscle
* increase in fat
* anemia, or low blood levels of iron
* decreased libido
* difficulty in attaining and sustaining erections

They say that these symptoms of "male menopause," also called andropause or viropause, can result from a decreased level of the male hormone testosterone and/or some of these risk factors:

* excessive alcohol consumption
* smoking
* high blood pressure, or hypertension
* prescription drug use
* nonprescription drug use
* poor diet
* lack of exercise
* poor circulation
* psychological problems

Not 'just aging' anymore

According to Dott, until recently, most doctors have considered these symptoms just part of aging and have ignored them. But now, he says, "we're beginning to realize we don't have to accept them all. We can accept the loss of strength, but to have to lie in bed at age 60 because of weakness and fatigue is not something we should accept."

Although men can experience a decline in testosterone levels with increasing age, and despite 150 years of attempts to rejuvenate men with hormone replacements, "male menopause" is still widely ignored. Malcolm Carruthers, a British specialist in men's health with a practice in London, suspects that one reason is historical.

Another problem associated with the diagnosis of "male menopause" is that only about 13% of men with symptoms have a low total testosterone level. Carruthers and others, however, say doctors need to evaluate the level of free active testosterone, or FAT, rather than total testosterone levels.

FAT is obtained by dividing the total plasma testosterone level by that of the sex hormone binding globulin, or SHBG.

This turns out to be low in 74% of the men with menopausal symptoms. SHBG increases with age and "zaps" the free testosterone before it can get into the cells to do its job.

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