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Is the “manopause” real?
If it is, it is nothing like the menopause
HOT FLUSHES; insomnia; joint pains; loss of libido: for many women, the menopause is no fun. Why exactly women become infertile decades before they die is a much-debated mystery in evolutionary biology. Besides humans, the only other mammals whose females experience so early a menopause in the wild seem to be some species of whale.
But equal opportunity is the spirit of the age. These days health influencers, supplement companies and even some doctors talk about a male version of the menopause—variously called the “manopause”, “andropause”, or, for acronym-lovers, “ADAM”, which stands for “androgen deficiency in the ageing male”. Symptoms include a flagging libido, tiredness, shrinking muscles and growing body fat.
Do men really suffer from menopause, or something like it? On one level, obviously not. Menopause is defined by the end of a woman’s** menstrual periods**, and therefore the loss of her ability to reproduce, usually by her early 50s. Men, by contrast, can stay fertile well into old age. For instance, Al Pacino, an American actor, fathered a child at 83.
In menopause, a woman’s levels of the sex hormones oestrogen and progesterone fall sharply and suddenly. In most men levels of testosterone, the main male sex hormone, likewise start falling during middle age. But unlike in women there is no sudden drop. Levels decline gently, at a rate of around 1% a year, and often stay within the normal range for a man’s entire life.
Sometimes symptoms that might be ascribed to a manopause may arise from the realities of middle-aged life. Tiredness is a common result of juggling work with family responsibilities. Flabbiness and atrophying muscles are the wages of years of sedentary office work and too little exercise.
That being said, some proportion of men do suffer from male hypogonadism, a medical condition in which the testicles do not produce as much testosterone as they should. Estimates of its prevalence vary widely: one review paper, published in 2020, cited one American study of ageing men that estimated 20% of those in their 60s might be sufferers. But a separate European study put the figure for the same age group at just 3.2%. The causes of hypogonadism are not always clear (though obesity seems not to help). But unlike the female menopause, it is not an inevitable consequence of ageing.
Menopausal women can be treated with hormone-replacement therapy (HRT). This aims to replace the missing sex hormones, and thus relieve unpleasant symptoms, using tablets or gels. Similarly, a growing number of men take testosterone-replacement therapy (TRT) to the same ends. Prescriptions have boomed in the past 20 years, **though there is not yet a firm consensus **on when men actually need it.
Still, testosterone—the original anabolic steroid—really is, in some ways, a fountain of youth. Men taking it will put on muscle, lose fat and recover faster from exercise (hence why taking testosterone is considered doping in most sports). The pros and cons of TRT are a subject for another article. But take care: side-effects can include baldness and, ironically, infertility. Add external testosterone and the body will compensate by making less. Reduced production in the testes can slow or even stop sperm production. By trying to relieve the symptoms of the supposed male menopause, men who take TRT risk replicating the defining feature of the female original. ■
熱潮紅、失眠、關節疼痛、性慾減退：對許多女性而言，更年期並不好受。
女性為何會在死亡前數十年便喪失生育能力，一直是演化生物學中的一大謎團。除了人類之外，目前已知在野外出現如此早期更年期的哺乳動物，似乎只有某些種類的鯨魚。
然而，「平權」是當今時代的精神。如今，健康意見領袖、保健品公司，甚至一些醫生，開始談論一種男性版的「更年期」——這種現象有各種名稱，如「男性更年期」（manopause）、「雄性更年期」（andropause），或對喜愛縮寫的人而言，稱作「ADAM」，即「老年男性雄激素缺乏症」（Androgen Deficiency in the Ageing Male）。其症狀包括性慾減退、疲倦、肌肉萎縮與體脂增加等。
但男性真的會經歷更年期，或者說類似的情況嗎？
某種程度上，答案顯然是否定的。更年期是指女性月經的停止，從而失去生育能力，通常發生於50歲出頭。而男性則不同，他們即使進入老年仍能保持生育能力。例如，美國演員艾爾·帕西諾（Al Pacino）在83歲時仍育有一子。
女性在更年期間，雌激素與黃體素等性激素會急遽且迅速地下降。而男性的主要性激素——睪固酮，則多半從中年開始逐年緩慢下降。但與女性不同的是，這種下降沒有劇烈斷崖式的變化，其速率大約每年1%，且通常一生中都仍維持在正常範圍內。
有時，被歸咎為「男性更年期」的症狀，其實可能源自中年生活的現實。工作與家庭責任兩頭燒導致的疲倦極為常見；身體鬆弛與肌肉萎縮則多半是長年久坐辦公、缺乏運動的後果。
儘管如此，的確有部分男性罹患「男性性腺機能低下症」（male hypogonadism），即睪丸無法產生足夠睪固酮的醫學狀況。其盛行率因研究而異。一篇2020年發表的綜合文獻指出，美國一項針對老年男性的研究估計，60多歲男性中約有20%可能患病。但另一項歐洲研究則認為，同齡族群的患病率僅為3.2%。其成因不總是明確（但肥胖似乎無助於改善）。不過，與女性更年期不同，這並非老化過程的必然結果。
女性更年期可透過荷爾蒙補充療法（HRT）進行治療，使用藥丸或凝膠補充缺乏的性激素，以緩解不適症狀。類似地，越來越多男性也選擇接受睪固酮補充療法（TRT）以達成同樣目的。過去20年間，相關處方快速增加，但何時應該開始治療，目前醫界尚未有明確共識。
不過，睪固酮——這種最早的合成代謝類固醇——在某些層面上確實堪稱「青春之泉」。服用睪固酮的男性會增肌、減脂，且運動後恢復得更快（這也是為何在大多數運動項目中，睪固酮被視為禁藥的原因）。至於TRT的利與弊，則是另一篇文章的主題。但必須小心：副作用可能包括禿頭，以及具有諷刺意味的——不孕。因為外源性睪固酮會使身體自我調節，減少睪固酮的自然產量。睪丸內的生成量降低後，可能導致精子產量減少，甚至完全停止。換句話說，為了緩解所謂男性更年期的症狀，服用TRT的男性反而可能重現女性更年期最關鍵的特徵。
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