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My husband is going through menopause

Your husband is acting strangely. He looks different and hasn’t been himself lately. What’s really worrying is that he’s behaving weirdly in bed. You don’t understand him lately… He was always reasonably well-built, but lately he’s developed a ‘spare tyre’ that rivals that of your pregnant daughter. You tell yourself that all men fill out as they get older, but all of a sudden, it seems that his muscles aren’t what they used to be. He seems to have less strength to open tight lids and pick things up, and his sculptured derrière has suddenly become soft and flat.

Of particular concern is that he seems irritated and unusually forgetful and has difficulty concentrating (he admits that he struggles to finish reading a book these days or to focus on his work). He sometimes looks depressed and lacks energy. You also suspect that he’s sleeping badly as he often complains that he still feels tired when he wakes in the morning.

Still more worrying is that he acts as if he desires you less – no more inviting texts that contain sexual innuendoes, fewer approaches on his part – it is almost as if he avoids sex, and this from a man who couldn’t keep his hands to himself!

Is it possible that your middle-aged husband is going through menopause? To answer this question, you need to know how testosterone works. Testosterone is the male sex hormone that makes him so different from you, and is formed mainly (90%) in his testicles. It influences literally every function in his body that has to do with reproduction – including the production of sperms, erections and his sex drive. It also plays an important role in his healthy functioning on many other levels.

Testosterone affects men very early on in life (long before they meet you), and plays a major role in the different stages of their development:

1. In his mother’s womb (the embryonic phase)

  • Testosterone is mainly responsible for the development of a male baby’s penis and urethra while his scrotum and testicles are developing outside his body.
  • Before the penis begins to grow, male babies look very similar to female babies.

2. Puberty

  • During this phase, higher levels of testosterone will cause further growth and development of the penis – something that most men remember fondly!
  • Higher levels of testosterone cause his larynx to become larger – sometimes to the great amusement of everyone around him, and to his own embarrassment, until his voice has finished breaking.
  • Testosterone gives the signal for the appearance of darker, thicker, longer hair – under his arms, on his pubic area, over his legs, chest and face – and this means that he can now shave like Dad.
  • The effect of testosterone on his skin is not always as welcome. It stimulates the activity of oil glands and is often to blame for transforming his skin from perfect to problematic… pimples, white- and blackheads erupt, but the oiliness does help smooth his skin and prevent dryness.
  • Testosterone causes the synthesis of proteins in his muscles which leads to an increase in growth and muscle mass. His muscles become clearer and more defined.
  • The hormone also causes him to have more erections as well as nightly emissions (‘wet dreams’).

3. His adult years

  • Testosterone increases his libido.
  • Testosterone together with another hormone, form the sperms in his testes. It plays a key role in his fertility.
  • Testosterone is essential to his ability to have an erection.
  • Testosterone and estradiol play an important role in the development and maintenance of his skeletal system and are responsible for the mineralisation of his bones and thus for bone density.
  • Testosterone stimulates the formation of new red blood cells.
  • This hormone is one of several which stimulate liver enzymes, influencing how his liver handles poisons, metabolises certain medications and processes alcohol.
  • Testosterone affects the way his body metabolises fat, and contributes to increased ‘healthy fats’ and decreased ‘bad fats’.
  • Testosterone lowers his risk of developing cardiovascular diseases (e.g. heart attack or stroke).
  • The masculine hormone affects his mood and psyche substantially – and it has positive effects on his morale and feeling of well-being.

Testosterone levels vary from man to man, but there is a normal range for different age groups. This level is usually some 30% higher early in the morning.

After the age of 35 to 40, men’s testosterone levels begin to fall gradually. The effect of this slight and gradual decrease is not immediately perceptible, but as the level of testosterone continues to fall – the symptoms become more obvious and more serious in some cases. This type of ‘masculine menopause’ is called ‘late onset hipogonadism’.

There are also other reasons for a lowered testosterone level such as when his testes stop functioning normally, or as a result of infection or damage, or when the hormones in his brain which stimulate the production of testosterone stop functioning optimally. These conditions are referred to as early onset male ‘menopause’ or hipogonadism.

Use the following AMS (ageing male’s symptoms) questionnaire to assess your husband:

Intensity of symptoms:

  •     None
  •     Slight
  •     Some
  •     Serious
  •     Very serious

Symptom (give all of the following symptoms a 1-5 rating according to the scale above):

  •     Reduction in his feeling of general health
  •     Joint / muscle pain
  •     Hot flushes / sweats
  •     Insomnia
  •     Increased need for sleep
  •     Irritation
  •     Nervousness
  •     Anxiety
  •     Lowered emotional and physical energy levels / chronic fatigue
  •     Reduction in muscle strength
  •     Depression
  •     A feeling of having passed his peak
  •     A burnt-out feeling
  •     Reduction in beard growth
  •     Reduction in sexual activity
  •     Reduction in morning erections
  •     Reduction in sexual drive / libido

Add his points together, and evaluate his testosterone levels as follows:

  • 26 or less: No reduction in testosterone
  • 27 – 36: Slight reduction in testosterone
  • 37 – 49: Some reduction in testosterone
  • 50 or higher: Serious reduction in testosterone

Other symptoms of low levels of testosterone may include:

  •     Erectile problems.
  •     Fertility problems.
  •     A decrease in sexual fantasies.
  •     Less spontaneous erections during the night.
  •     An increase in waist girth!
  •     Formation of breasts / a fatty layer beneath his nipples.
  •     Skin becoming dry and wrinkled.
  •     Reduced levels of concentration.
  •     Reduced appetite.
  •     Restlessness.
  •     Forgetfulness.
  •     Chronic fatigue.
  •     Confusion.
  •     Loss of typical male hair distribution pattern.
  •     Thinning of the blood.
  •     A tendency to break bones.
  •     Metabolic syndrome (a combination of a large stomach, diabetes, high cholesterol and high blood pressure).

This last-named is a particularly serious problem because metabolic syndrome is a high-risk factor for the development of cardiovascular diseases such as heart attack and stroke. It is recommended that you pay attention to changes in your husband’s sexual behaviour (along with all the other symptoms) as these symptoms can be early warning signs of a much greater underlying problem threatening his health!

If the above symptoms sound familiar – advise your husband to go for a simple blood test in order to obtain peace of mind that his testosterone levels are normal. If his levels are normal, the cause of his symptoms must be investigated further. A physical check-up is also important to confirm the signs of lowered testosterone levels and to evaluate his health in general.

The good news is that slightly low and even seriously low testosterone levels are treatable using various treatment options. The methods used to treat low levels of testosterone have developed extensively over the past few years, and are much more refined and sophisticated than they were previously. There are wonderful options available which have minimal side effects, and ensure full augmentation in testosterone levels.

If you do have questions around this subject, you are advised to seek professional advice to ensure that you get help with coping with the emotional and medical implications that this condition may pose. But if your husband’s testosterone level is still high – enjoy its effects!