Psychologically Speaking: Depression or andropause

Women are well known to go through menopause, but men, too, can suffer from the effects of decreasing hormone levels.

By DR. BATYA L. LUDMAN
anxiety 88 (photo credit: Courtesy)
anxiety 88
(photo credit: Courtesy)
Dear Dr. Batya, I am a man in my mid-50s and when I am honest with myself, I've noticed some changes over the past year that neither I nor my wife are happy with. I've been more tired lately and have even fallen asleep at the dinner table. I feel down, have less energy, am less interested in sex; my wife and children say that I am more irritable, moody and stressed, and I while I never really thought I had much of a middle-age bulge, I seem to have fat and sagging where I don't remember having it before. Can it be that I am depressed and am not even aware of it? I was wondering if you see many men with the same sort of vague complaints and if so, what do you suggest? Is this what they mean by a mid-life crisis? Is there a medication that could help? G.H., Petah Tikva Since most men suffer in silence, I am very glad that you have written and are looking for help. It is absolutely possible that you are depressed and some of the symptoms you describe - lack of energy, decreased pleasure in sex, sadness and a possible change in weight - are seen in depression. You can certainly see a clinical psychologist or physician to have this assessed. However, in reviewing your symptoms, I think it would be a mistake to jump to the conclusion that you are simply depressed without doing further medical testing, and if you were to see me, I would send you off to your family doctor to have these evaluated first. Given your age, I might wonder about andropause, or "male menopause," because quite frankly, the symptoms you describe could also fit into this profile as well. Some simple blood work may reveal decreased testosterone levels that may, in part or in total, account for what you describe. Women are well known to go through menopause, but what is less commonly known is that men, too, can suffer from the effects of decreasing hormone levels. While most women living with a man who seems more irritable, less interested in her sexually and just devoid of energy might hint that her partner is also aging, andropause just doesn't get the same attention. Men more typically don't get the help they deserve. As a result, I frequently see and hear of men described by their wives as grumpy, disinterested and uncommunicative, lacking both desire and ability to perform in bed, uninterested in being with them and yet glued to, and falling asleep in front of, the computer or television. They seem not to care about anything or anyone. Men are often reluctant to talk about their waning sex lives, and sadly, while they may present themselves to their family doctor for various reasons, sex is often not a topic that gets brought up or even discussed, in spite of its importance in a healthy relationship. This seems true regardless of age. At times there really are other concerns and issues which complicate making a definitive diagnosis, and thus make treatment issues more complex. These may include poor communication, issues around job dissatisfaction, health related or financial difficulties as well as depression. Nevertheless, I certainly would start out by first dealing with any medical issues. If the blood tests are negative, or if the other issues are pervasive, it then makes sense to be seen by a psychologist to help you deal with the medical findings as well as the other stressors in your life. Let's take a more in-depth look at andropause and what is often involved. With increasing age, starting from about 30, males experience a gradual decrease of the hormone testosterone. Often this decrease is so gradual that unlike menopause, which occurs quite rapidly and clearly impacts most women as they hit middle age, men may slowly start to feel that things are somewhat different. This can come on so gradually that it often gets missed, yet a significant number of men after age 50 reportedly experience the effects of decreased levels of testosterone. One often assumes that with increasing age, sexual, mental and physical ability are simply not what they once were, and instead of seeing if there is an actual cause, it often seems easiest to simply ignore the subtle symptoms and chalk it up to age. So while hormones can enable a man to feel "macho," they can also be the cause of night sweats, memory loss, confusion, difficulty with making decisions, depression, irritability and erectile dysfunction involving both difficulty in achieving and maintaining an erection. A deficiency in testosterone can also result in fatigue bordering on exhaustion, changes in mood and attitude, less bone strength, disturbed sleep, increased urinary frequency, loss of muscle mass and even a possible loss in height to go along with osteoporosis. Low testosterone may result from many things, such as radiation therapy and medications, and it is important to determine their impact or at the very least to determine the actual cause. In addition, many of the symptoms you describe and that are seen with testosterone deficiency are also seen in other conditions. Thyroid and other hormonal disorders, diabetes, medications, hypertension, all more common in the aging male, can be the root of the problems, and need to be evaluated. Finally stress and depression must also be evaluated as they may be the cause of the symptoms, may exacerbate already existing problems, or may result from the difficulties experienced as the result of waning testosterone levels. The good news is that there is something to do about your problem. If indeed you are found to be testosterone deficient, there is testosterone replacement therapy which for many has been beneficial. If the cause is found to be related to other medical issues, this too can usually be treated. Finally, if the cause is depression, depending on the severity, cognitive behavior therapy and, if indicated, antidepressants, have been found to be very effective. As with any and all of the above, a healthy diet, sleep, exercise and stress reduction techniques are a great place to begin. Now that you've taken the first step, a solution is on the way. The writer is a licensed clinical psychologist in private practice in Ra'anana. ludman@netvision.net.il