SAN ANTONIO (San Antonio Express-News) - Retired Houston truck driver Clifton Cormier thought he was ``just getting old'' several years ago when he started feeling more aches and pains than usual and was constantly tired. More distressing, his memory wasn't as sharp as it used to be.
``I'd do a crossword puzzle, and the next day I could almost do it again - I'd forgotten all the answers,'' said Cormier, 76. ``And my muscles were shrinking. The backs of my legs looked like prunes.''
Fortunately for Cormier, his doctor recognized these as more than symptoms of advancing years and referred him to Dr. Robert S. Tan, a Houston geriatrician, a doctor who specializes in care of the elderly. After getting the results of a blood test, Tan, the author of ``The Andropause Mystery'' (AMRED Publishing, $19.95), immediately prescribed testosterone replacement therapy.
Cormier's diagnosis may not have said so specifically, but what he was experiencing was what is popularly known as male menopause. Sometimes called ``puberty in reverse,'' this is the period in a man's life when production of a number of vital hormones - primarily testosterone - begins to decline. The facile comparison, of course, is with female menopause. But there are important and distinct differences between the two.
Indeed, not everyone buys into the concept that male menopause even exists. The public perception is that male menopause is the punch line of a hoary joke, complete with references to hot cars, hot babes and, yes, hot flashes.
Physicians are not among the nonbelievers. Earlier this month, at the San Antonio meeting of the American Association of Clinical Endocrinologists, there were two major presentations on treating androgen deficiency. (Androgens are a group of hormones of which testosterone is the most powerful.)
One source of the confusion is the name used to describe the syndrome. ``Calling it male menopause is biologically silly and anatomically improbable,'' said Dr. Richard F. Spark, the Harvard Medical School professor whose 1980 Journal of the American Medical Association article was among the first to suggest that impotence isn't always all in a man's head.
The word menopause means a pause, or cessation, of the menstrual cycle. And since men don't have menstrual cycles, they can't stop having them.
Not that the medical community hasn't tried to coin alternatives. What the lay public calls male menopause has been referred to, at times, as hypogonadism, viropause and ADAM (androgen decline in aging males). The name that seems to have the best odds of sticking is andropause, or the cessation of production of androgens.
Produced in the testes, testosterone is the hormone responsible for many of the attributes that define a male. In the womb, it shapes the male genitals. During adolescence, well-timed surges of the stuff help turn a boy into a sexually mature, deep-voiced, hirsute man.
Sometime between age 45 and 60 (younger for some men, older for others), testosterone production slows and less and less is pumped into the bloodstream. However, unlike estrogen production in women, which comes to an abrupt and complete halt with the onset of menopause, testosterone levels in men taper off gradually during many years.
This long, slow decline means that men - who are usually not as in touch with their bodies as women - are often unaware of the subtle changes they're undergoing.
``Usually a patient will come in for other issues, and when I ask about, say, sexual functioning, they say, `Oh yeah, that's a little off, too,''' said Dr. Jerome S. Fischer, an endocrinologist at the Diabetes & Glandular Disease Clinic in San Antonio.
Symptoms of male menopause will sound eerily familiar to any woman who already has undergone the change: irritability, mood swings, depression, anxiety, palpitations, memory loss. About one in 10 men even suffer hot flashes.
And since testosterone plays such a vital role in sexual functioning, a drop in production usually triggers a concomitant decline in libido and virility and an increase in erectile dysfunction. This doesn't necessarily relegate a man to complete impotence, only a loss of the anywhere/anytime erections of his younger days.
But male menopause involves more than just physical changes.
``Sure it's a physiological event,'' said Jed Diamond, the author of ``Surviving Male Menopause'' (Sourcebooks, $16.95). ``But these changes also affect a man psychologically, socially and interpersonally. Treating the syndrome means treating these problems, too.''
Diagnosing male menopause is often a matter of taking a medical history and doing a complete physical. Often, it's the simple things that shed light on the problem.
For example, a man who suddenly has to shave only once or twice a week instead of every day may well be suffering testosterone deficiency. On the other hand, the presence of so-called male-pattern baldness is usually a sign (albeit an unwelcome one) that a man has sufficient amounts of the hormone.
Doctors who suspect a problem probably will order a series of blood tests. Because testosterone production occurs in spikes throughout the day, several are needed during two to three hours.
While relatively few patients are found to be clinically deficient in testosterone, those who are can be treated with either hormone injections or newer gels or patches applied to the skin. For most men, the results are dramatic and almost immediate.
Cormier said he started seeing a difference after only his second once-a-month shot. ``My memory's sharper, I'm more mobile, my quality of life is much better,'' he said. ``I'd even thought that nighttime erections were a thing of the past, but they're back.''
While testosterone replacement is usually effective, physicians caution it should be used only to treat clinical deficiencies. It is not, said Fischer, a supplement or a vitamin and must be administered under strict medical supervision.
Side effects include increases in both cholesterol and blood pressure, growth of body hair, male-pattern baldness, acne and fluid retention. All are treatable.
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