Understanding the mid-life crisis

The menopause is a well-known event for women, even celebrated, though this has been late in coming to the understanding of men -- and male doctors in particular. What is much less known is that men have to endure a similar biological and emotional experience. It is obscured by the usual male inability to come to terms with personal issues and the fact that it is perceived as less than masculine to even admit to such feelings.

Matters are made more complicated by the fact that there are really two phenomena rolled into one and these easily become confused. It is vital that women appreciate what is happening to their loved one and that doctors get to grips with this important aspect of growing older. Although men like to believe they are tough and immune from care, the truth is they are often desperately insecure and failing to understand what is happening to one’s self can be a major cause of anxiety and suffering.

There is a male hormonal shut-down, akin to the menopause, which is therefore named the “andropause”. But this is quite distinct from the mid-life crisis, as we shall see in detail. The trouble is that both happen at a similar time, though the crucial difference is that the mid-life crisis tends to occur somewhat earlier. How can we tell these two apart?

Let us consider first the true andropause.

Characteristics of the andropause

It starts, usually, in the fifth decade. It is unrelated to life events (though it may happen at the same time as an unrelated disaster). There are true biological changes, which can be measured in the laboratory. Testosterone levels fall. The resulting symptoms are not unlike those experienced by a woman at the menopause:

fatigue
depression
aches and pains
sweating and flushes
reduced libido

To which may be added: loss of erectile function. The latter is particularly disturbing to a man and difficulty in talking about this problem is one of the reasons why the male menopause has been little attended to.