Q: Although I am only 50 years old, my interest in sex and my strength have decreased in the past year. Could I be going through a kind of male menopause?
A: The menopause in women results from a rather abrupt and near total loss of ovarian function that leads to a dramatic fall in the formation and blood levels of the female hormone estrogen.
By contrast, as men age, there is a decline in blood levels of the male hormone testosterone, but the fall is relatively small and slow in most men.
As a result, testosterone levels in most older men are maintained in the same range that is considered normal in younger men.
It is true that, as they age, men tend to develop a decrease in libido (sexual desire), potency (erectile function), muscle strength and bone density. Some of these changes may be due to low levels of testosterone production, but they may also be caused by a variety of illnesses, such as heart disease and
cancer, that increase in frequency as men (and women) grow older.
While estrogen replacement is widely recommended for women
after the menopause, testosterone administration is currently prescribed primarily for a small number of young men whose blood testosterone levels are clearly quite low. In such men, testosterone replacement does improve strength, libido and erectile function.
Limited information is available on the benefits and possible risks of testosterone treatment in older men. Testosterone may improve function in the relatively small percentage of older men whose testosterone levels are markedly low.
On the other hand, administration of testosterone to older men poses the twin dangers of increasing the risk of an enlarged prostate (benign prostatic hyperplasia) and prostate cancer since both are known to be adversely influenced by testosterone.
It is quite unlikely that the symptoms you describe at age 50 are the result of an age-related fall in your testosterone level. Your symptoms may be caused by some disorder of testosterone production or to some other problem entirely unrelated to testosterone.
As a first step, you should ask a physician to check your testosterone level.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.