The term “male menopause” is really a misnomer; we know this, yet for the sake of simplicity and the use of common terms to communicate understanding we will keep the term and permit ‘researchers’ of this topic to embrace understanding as to why. Another popular word for this is “andropause” which also is a misnomer. During a 2006 convention in Amsterdam the real “term” for this condition came under review. Dr. A Morales of Canada gave the following proposal - Men, as they age, often develop symptoms of increased fatty girth, decreased muscle mass and erectile dysfunction along with other negative bodily changes.
For many men, it is clear that these changes parallel decreases in serum testosterone levels. Hence, the syndrome has been called variously “Andropause”, “Androgen Decline in the Aging Male (ADAM)” or “Late Onset Hypogonadism (LOH)” or by other terms.
Now, Dr. A. Morales of Canada and several other colleagues from throughout the world propose to unify the name of the syndrome as Testosterone Deficiency Syndrome.
The authors present compelling arguments for the acceptance of this name. They prefer the use of testosterone rather than androgen, since it is the active and measured agent.
They also point out that, although the process of TDS is more common in midlife or older men, it is not restricted to that age group. It can be linked descriptively as necessary to other diseases through the use of dual terminology, e.g. TDS in Diabetics. They therefore urge acceptance of this term as a means of standardizing the nomenclature for future use.
We are however, motivated much differently; we aim to communicate “understanding” to the populace without splitting hairs over the descriptive terms. Lets just call it “male menopause” or ‘andropause’ for now and kick in the proper terms later on.
Andropause - what is it? With a casual look in the dictionary you probably wouldn’t find it. So what is it? Well, the medical dictionary calls andropause “An age-related decline in serum testosterone levels in older men to below the normal range in young men that is associated with a clinical syndrome (i.e., symptoms and signs) consistent with androgen (testosterone) deficiency".
Don’t let this definition scare you though; decreasing levels of testosterone production in the male body is normal to aging. The drop off in testosterone production begins as early as your college years. It normally occurs so gradually that a man in his twenties through thirties will seldom even notice. This decline however becomes more important to a man as he reaches midlife.
With recent generations of men experiencing a much longer life span than the generations prior the midlife issues that we face today are common to men between the ages of 34 to 60, give or take a year or two. Andropause (also called “male menopause) is one such issue that requires our attention.
Author Jed Diamond, in his book Male Menopause says “the most common problem associated with male menopause is depression which is closely related to impotence and problems with male sexuality.”
It is expected that “approximately 40% of men in their 40s, 50s and 60s will experience some degree of difficulty in attaining and sustaining erections, lethargy, depression, increased irritability, and mood swings that characterize male menopause.”
The symptoms of depression in men remain more often unrecognized. The menalive website reports that there are several reasons for this:
A. The symptoms of male depression are different than the classic symptoms we think of as depression.
B. Men deny they have problems because they are supposed to "be strong".
C. Men deny they have a problem with their sexuality and don't understand the relationship with depression.
D. The symptom cluster of male depression is not well known so family members, physicians, and mental health professionals fail to recognize it.
Male depression has devastating consequences;as indicated in Jed Diamond's book Male Menopause:
- 80% of all suicides in the US are men.
- The male suicide rate at midlife is three times higher; for men over 65, seven times higher
- The history of depression makes the risk of suicide seventy-eight times greater (Sweden)
- 20 million American will experience depression sometimes in their lifetime
- 60-80% of depressed adults never get professional help
- It can take up to ten years and three health professionals to properly diagnose this disorder
- 80-90% of people seeking help get relief from their symptoms
"We see them as bad boys rather than sad boys"
Harvard psychologist William Pollack, Ph.D insists that depression is vastly under-diagnosed in men. “When the body count is taken, depression may be as common among men as it is among women, although current dogma holds that depression favors women two to one.” Dr. Pollack and others contend that culture goes to work early on boys to suppress their real rate of suffering. "Boys are trained in ways that make it likely they get depression later. If it doesn't destroy their relationships sooner, it shows up by midlife. Midlife crisis is a euphemism for male-based depression."
Terence Real, MSW, of the Family Institute of Cambridge reports concerning male and female depression that there are many men who experience the "classic" signs of depression, too. But there is a difference even in them, they hide it. Their shame at having feelings inconsistent with the male role silences them. They suffer a compound depression--on top of their now-hidden depression they are depressed about feeling depressed.
Even more men exhibit what Terence Real calls covert depression. "You don't see the depression itself but the defensive maneuvers men use to evade or assuage it," says Real.
The Signs include:
- Self-medication. First and foremost is drinking, but also abuse of other drugs.
- Risk-taking, including compulsive gambling, womanizing, and acts of bravado that show up as high rates of accidental death. These are "desperate acts" that both numb the pain and show the world "I'm a real man" by denial of vulnerability. "We see them as bad boys rather than sad boys."
- Radical isolation. Men withdraw from relationships, from their wives.
- Lashing out. This can run the gamut from increased irritability to domestic violence.
Women internalize depression and tend to blame themselves; men tend to externalize distress and blame others. Men move into action--and distraction.
To sum things up, men tend to mask their depression by external actions that we use to numb the pain we feel inside and in order that we not disclose ourselves to the world. This self-medication tends to work at forcing the depressed feelings “under ground”. When the self medicating stops the depression is still there. This self medicating is commonly called “Midlife Crisis”.
Differences between Male and Female depression
Men are more likely to act out their inner turmoil while women are more likely to turn their feelings inward. This list from Jed Diamond's book Male Menopause illustrates these differences.
- Female: Blame themselves
- Male: Feel others are to blame
- Female: Feel sad, apathetic, and worthless
- Male: Feel angry, irritable, and ego inflated
- Female: Feel anxious and scared
- Male: Feel suspicious and guarded
- Female: Avoids conflicts at all costs
- Male: Creates conflicts
- Female: Always tries to be nice
- Male: Overtly or covertly hostile
- Female: Withdraws when feeling hurt
- Male: Attacks when feeling hurt
- Female: Has trouble with self respect
- Male: Demands respect from other
- Female: Feels they were born to fail
- Male: Feels the world set them up to fail
- Female: Slowed down and nervous
- Male: Restless and agitated
- Female: Chronic procrastinator
- Male: Compulsive time keeper
- Female: Sleeps too much
- Male: Sleeps too little
- Female: Trouble setting boundaries
- Male: Needs control at all costs
- Female: Feels guilty for what they do
- Male: Feels ashamed for who they are
- Female: Uncomfortable receiving praise
- Male: Frustrated if not praised enough
- Female: Finds it easy to talk about weaknesses and doubts
- Male: Terrified to talk about weaknesses and doubts
- Female: Strong fear of success
- Male: Strong fear of failure
- Female: Needs to "blend in" to feel safe
- Male: Needs to be "top dog" to feel safe
- Female: Uses food, friends, and "love" to self-medicate
- Male: Uses alcohol, TV, sports, and sex to self medicate
- Female: Believe their problems could be solved only if they could be a better (spouse, co-worker, parent, friend)
- Male: Believe their problems could be solved only if their (spouse, co-worker, parent, friend) would treat them better
- Female: Constantly wonder, "Am I loveable enough?"
- Male: Constantly wonder, "Am I being loved enough?"
The Question remains; are you in a midlife crisis now? Take the "midlife crisis quiz" to find your results.