I am a man and want to understand menopause

Dear Dr. Milrod:

There must be thousands of books on menopause, and yet in some ways it still seems a mystery.  Women can get it as early as 45, and it can last anywhere from 2 to 15 years, no?  Or are there no rules?  Does sexual desire always decline in women during/after menopause?  Are exceptions frequent? I am a “mature” man, and although my frequency and quality of performance have declined inevitably with the passage of time, my desire is almost as keen and returns quickly after a good session with a new partner.  Do men produce more testosterone than women when they reach their late 50s-60s?  It would seem so, and women who use testosterone to get back their libido seem to run a high risk of cancer. True? Older men seem much more sexual than their wives, but there is often a lot more going on than just testosterone, e. g. happiness in the marriage/relationship, developing outside interests beyond sex, where women seem more adept at this than men.

Polo Player

Dear Polo Player:

A complete reply would indeed fill several volumes, so I’ll just address a few of your key questions: Women can enter the peri-menopausal stage as early as 35…or as late as 50. Literally, the word “menopause” means complete cessation of menses, i.e. the monthly period. That stage is preceded by years of “peri” menopause, meaning “around” the menopausal years. It is during that stage that women’s hormones go up, down, sideways, backwards, and begin to affect mood, appearance, health, etc. The peri-menopausal years can stretch 10-15 years. It’s not an exact and predictable event, and many women are unaware of their own condition.

DNA governs fecundity in humans. Menarche [first period] and reproductive capacities are largely heritable. So you could have a whole family of women who started their perimenopausal years around 35-40, and another where menopause came much later in life. But generally, we’re all pre-menopausal before 35, unless there is some unusual condition like ovarian failure and the like. Such unusual conditions would be the “exceptions.”

It is absolutely impossible to parallel men’s testosterone levels with that of women’s. Women make testosterone principally in their adrenals, men in their gonads. Cut a man’s testicles off, and his testosterone levels will plummet to near zero. Hence, healthy men always produce incomparably more testosterone than women. Testosterone is an androgen, meaning a male hormone. The fact that women produce the small amount they do is good, because that is what’s largely responsible for their sexual urges in the long run.

As for women taking testosterone, another danger is liver damage, not just cancer. But you’d have to take very high levels for many years to run the risk. Remember that there are many women out there who transition from female to male [FTM transsexuals.] They inject bi-weekly with enough testosterone to masculinize their bodies completely, including growing beards, deepening their voices, putting on muscle mass, etc. If they are under responsible medical care, they get their liver enzymes monitored and go through blood testing on a regular basis. But a woman who is merely interested in regaining some of her sexual desire will most often go on a patch containing minute amounts of testosterone…not enough to see a cancer-related cause and effect.

Recent research points to the fact that many post-menopausal women, despite hormonal patches, pills and creams containing both estrogen and testosterone, fail to demonstrate increased sex drives. This has lead researchers to ponder the eternal question – what makes a woman truly horny? My bet is on the LH surge – the lutenizing hormone surge involving an intricate dance between estrogen and progesterone that women experience just prior to ovulation. Nature, in its infinite wisdom, encourages “horniness” in women right before they are about to pop that monthly egg, just so that we all can get fruitful and multiply. But to create that natural surge in post-menopausal women is like trying to direct a Shostakovich symphony in the dark with no baton. Women, due to their double X chromosomes are extremely individual, and what works for one woman may not work for another. Since men are X-chromosomally challenged in comparison, there is less variance, and medical interference creates a more uniform response.

On the whole, men will usually be more libidinous than women, thanks to much higher testosterone levels. Now, “does sexual desire always decline in women during/after menopause?” Not always. Some women report increased sexual desire, since their testosterone levels remain constant before, during and after menopause. Their estrogen and progesterone levels do decline, thereby no longer opposing testosterone levels. This is why some post-menopausal women masculinize in appearance, lose hair on the head, sprout some extra on the chin, get thicker in the waist, etc. Meanwhile, their testosterone levels pretty much remain constant, since the principal amount of testosterone is made in their adrenal glands. With the dampening effect of estrogen and progesterone gone, some women do get hornier indeed! Of course, such women may have to obtain some local estrogenic lubricant to prevent vaginal tissues from atrophy, which could make sex painful.

Yes, there are other things in marriage/relationships beyond sex. Yes, women do seem more adept at creating non-sexual relations than men. Again, they are hormonally primed for such tasks, what with higher production of oxytocin, capacity for childbirth, etc. Estrogen, the principal female hormone also affects women, prompting them to bond, not just with men, but also with other women. We see this in men who become women, i.e. male-to-female (MTF) transsexuals. Once on the appropriate feminizing hormones, e.g. estrogen, progesterone and anti-androgens (testosterone suppressants,) they can go from being the horniest person in the world, to just wanting to sit at home and cuddle with someone in front of the fireplace.

Finally, don’t think that men are entirely safe from the ravages of time. Andrology – a burgeoning field, and a way to medicalize, and perhaps profit from, men’s natural developmental trajectory – has now given you the condition of andropause. Yes, men go through a “change of life” as well. Perhaps not as radical, but enough for pharmaceutical companies to release testosterone patches, shots for men and HGH (human growth hormones) for the worried well.

Christine Milrod, Ph.D.

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