What Is Male Menopause? Symptoms and Treatment After Cancer Therapy

Cancer treatments can cause some men menopausal complaints similar to women's. For example, prostate cancer hormone-suppressing treatments may cause hot flashes, sweating and reduced sexual desire as symptoms. These adverse effects can be distressing and difficult for men.

This article explains how menopausal complaints during and after cancer treatment affect men's lives and how to cope.

What Is Male Menopause?

Male menopause is also called andropause, meaning age-related testosterone decline and resulting symptoms. More medically, testosterone reduction due to aging, independent of other diseases, with related clinical symptoms is termed andropause (late-onset hypogonadism) . Diagnosis requires serum testosterone < 8-11 nmol/L or < 300 ng/dL.

By age 60, of every 3 men almost 1 develops testosterone deficiency; after age 80, of every 2 men, 1 does.

Men do not experience menopause like women, whose estrogen and progesterone production rapidly declines, causing psychological and physical symptoms. Men's testosterone production declines with age too, generally gradually. During this time men may experience:

• Emotional distress and irritability
• Sexual problems (erectile dysfunction or loss of libido)
• Fatigue and weakness altering sleep patterns
• Reduced energy
• Hot flashes and sweating
• Depressed mood and
• Lack of motivation

- Related topic: Testosterone Deficiency Symptoms, Treatment, Andropause and Prostate Cancer

The link between these symptoms and testosterone decline remains debated. However, some cancer treatments cause effects resembling female menopause. The cancers where this is most common are prostate cancer and male breast canceras examples. All cancer treatments can otherwise cause low testosterone, the above complaints and male menopause.

Hormone Suppression and Prostate Cancer

Prostate cancer hormone treatments can cause menopausal symptoms because they lower hormone levels. Effects depend on drug dose and type. Short-term effects in treated men may include:

• Hot flashes and sweating
• Sexual problems
• Fatigue, weakness and exhaustion
• Breast tenderness

These may occur soon after treatment starts.

Hot Flashes and Sweating

Some drugs that suppress pituitary function to prevent testosterone production cause excessive sweating, resembling women's menopausal hot flashes. Examples include goserelin acetate (Zoladex), buserelin (Suprefact) and leuprorelin (Prostap). Flashes and sweating may cause facial redness and faintness. They may diminish after using the drugs for a while, but sometimes continue throughout treatment.

Recent studies suggest the antidepressant venlafaxine or acupuncture may reduce hot flashes, but these options should be discussed with your doctor.

For Hot Flashes and Sweating:

• Keep your home cool — use a fan
• Wear light cotton clothes
• Reduce alcohol, caffeine and nicotine
• Stay out of the sun
• Shower with cool water
• Keep clean towels bedside for night sweats
• Drink plenty of water without waiting for hot flashes

Sexual Problems

Hormone drugs can cause erection difficulties by stopping testosterone production. Depending on the drug, this may be temporary or permanent. Around half of men taking antiandrogens such as bicalutamide (Casodex) have no erection problems and continue their sex lives. Prostate removal, radiotherapy and other treatments may also cause erectile problems.

Ask your doctor about medication to help achieve erections.

Discuss sexual feelings with your partner so they understand the process and why intimacy may sometimes be difficult.

Sexuality is not only penetration: kissing and cuddling also create closeness. Sexual counseling may help during this period.

Feeling Weak and Tired

Prostate cancer hormone treatment commonly causes fatigue and weakness.

To help reduce fatigue:

• Do gentle exercise daily to increase energy
• Be kind to yourself and rest when tired
• Plan your day
• Do important activities when energy is highest
• Eat a healthy, balanced diet to maintain energy.
• Ask for help with shopping, cooking and daily tasks.

Supportive therapies such as massage, yoga, acupuncture, tai chi, psychotherapy and relaxation techniques may help reduce stress and increase energy and a sense of control.

Long-Term Effects of Male Menopause

Men on hormone treatment also face long-term adverse effect risks, including:

• Weight gain
• Bone weakening (osteoporosis)
• Mood changes, depression and memory problems
• Bone Thinning / Fractures

Cancer treatments lowering or blocking hormones may reduce bone density (osteoporosis), increasing fracture risk. Your doctor may screen and recommend continued running, walking, cycling and regular weight exercises to strengthen bones. Drugs such as bisphosphonates or denosumab can also prevent bone loss; ask your doctor whether they suit you.

Weight gain

Weight control may be difficult during hormone treatment. Maintain regular daily exercise and a healthy, balanced diet.

Memory Changes

Hormone treatment sometimes affects memory, generally improving afterward. Notes and diaries can help avoid forgetting important things during treatment. Discuss significant changes with doctors and nurses.

Male Breast Cancer and Menopausal Symptoms

Male breast cancer is very rare. Its treatments can cause menopausal complaints. Tamoxifen is the most common hormone treatment in men with breast cancer. Tamoxifen may cause hot flashes, sweating, emotional changes, weight gain, low sexual desire, weakness and memory changes.

- Related topic: How Can Men Recognize a Breast Lump? Could It Be Cancer? Symptoms and Treatment

Emotional State

Menopausal symptoms can be emotionally distressing. Some days you may feel well; others angry, irritable or low. You may wonder what is happening and whether normality will return. Share feelings with your partner, friends and family.

Meeting and talking with other men with cancer may provide information and support, as can doctors and nurses.

Many men find expressing emotions difficult. Cancer support groups or counseling can help greatly.

Sadness, anxiety and loneliness are normal with these complaints. But if symptoms persist and mood remains low, see your doctor; you may have depression. Much can be done to treat it, but first share it with someone. Earlier help makes treatment easier. Depression is not weakness but a medical condition affecting many people and requiring treatment.

Testosterone Treatment for Male Menopause and Precautions

In aging men, testosterone appears to benefit appearance, muscle/fat balance, bone density, insulin resistance and cholesterol profile. However, evidence on muscle strength, sexual function and mood remains debated.

Regular monitoring is recommended to protect against testosterone adverse effects. Before treatment, total blood testosterone, PSA, liver enzymes, hemoglobin, hematocrit and cholesterol profile must be checked, then periodically afterward. The aim is the lowest dose relieving complaints; raising testosterone to the target (250-300 ng/dl) is considered sufficient.

• What Is Menopause? Symptoms, Effects and Management Strategies