Beyond the Male Menopause

One of my medical school professors was an internationally renowned subspecialist, whose ward occupied the entire top floor of the medical tower at Academy Hospital in Uppsala.

He had cadres of residents working for him, and for two glorious months I rotated through his ward as part of my internal medicine training in medical school.

One thing that stands out in my memory, to this day, from those two months is how Professor B refused to deal with anything but the esoteric diseases his patients came to his ward for. If anyone had a cough or an ache or a rash, he would scornfully say “I treat diseases, not ailments”.

It seems that nowadays many ailments have been given disease status. Restless legs, premenstrual syndrome, thinning hair and overactive bladder are bona fide diseases now.

Even aging is, in this country, largely viewed as a constellation of diseases. It strikes me as odd that in this age of high regard for Evidence Based Medicine, we so boldly define things that happen to all of us sooner or later as diseases and try out treatments for these symptoms when every shred of available evidence suggests these are actually natural occurrences.

When I was a resident, I got docked if I didn’t offer postmenopausal women estrogen replacement. It seemed like such an obvious thing to do – who wouldn’t want to keep women from aging as nature had so cruelly intended? Who wouldn’t want to save them from heart disease, dementia, osteoporosis, genito-urinary symptoms and decreased joie de vivre? Who wouldn’t want to preserve and prolong youth?

Now, of course, everyone agrees that estrogen replacement increases a woman’s breast cancer risk and also increases her risk for blood clots, stroke and heart disease.

The male aging process seems to be the current frontier for many of those who wish to medicalize the human experience. As if we never learn from our mistakes, we are now prompted to look for low testosterone levels in middle-aged and older men, who might not have their usual vitality, muscle mass or sex drive anymore.

Never mind that there are already concerns about what male hormone treatment might do to prostate cancer and maybe even heart disease risks.

I wonder when the drug companies will focus their attention on the other big transition we all go through.

Adolescence is a life-changing condition for both girls and boys with many undesirable, hormone-mediated “symptoms”. Every generation of parents and teenagers until now has had to go through it without help from the pharmaceutical industry. If we were to follow the menopause-and-aging-as-diseases logic, this is probably the next medical frontier after we conquer the male menopause. Just think of all the “patients”, who suffer their way through this “disease”.

It’s probably only a matter of time until we have diagnostic codes and blockbuster drugs for this, too.

1 Response to “Beyond the Male Menopause”

  1. 1 Jennifer Scott ARNP, FNP-BC May 29, 2010 at 6:20 pm

    I do tend to treat patients with low testosterone if they are young. I do a baseline PSA and use the least amount of hormone to do the trick. I stumbled onto low testosterone long before the commercials on television were touting it as the new thing to do. My male patients were coming in on all sorts of depression medications and feeling terrible. Once I found the true reason for their fatigue and loss of interest in activities, they are able to stop taking mood altering medications that were unnecessary. I also ask women about their hormone replacement needs and base it on how it affects their lives and how important sex is their relationships. I also require that both people in the relationship be involved because one may find it more important than the other and I don’t want to be the one to wreck a relationship or cause an affair. I go over the risks and benefits and family history thoroughly before we make the decision together.

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