Blog of the Society for Menstrual Cycle Research

Male Menopause, Andropause and now “Manopause”?

August 22nd, 2014 by Heather Dillaway

August 18, 2014 cover of TIME magazine

By now, everyone has probably seen this week’s TIME cover story. The magazine’s August 18th cover photo showed a topless, seemingly frumpy, middle-aged man worried about his loss of testosterone and (therefore) manhood under the title, “Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry”. The cover story details the booming testosterone (“Low-T”) industry in the U.S., describing the reasons why middle-aged men might go to the growing number of Low-T clinics for treatment. While the article draws some interesting parallels to the hormone therapy industries that have targeted women and highlights some of the important risks and unknowns about Low-T treatments, there are some interesting gaps and missteps in the article that are worth detailing.

First, if we are going to talk about a male menopause, can we please pick one term? This author of this article refers to male menopause, andropause, and then titles his article “manopause.” So, which is it? Having all of these terms floating around is just confusing. As we know from research on women’s menopause, having more than one term or having vague terms for a health condition just leads to confusion. This article adds to the confusion over terminology.

Second, the article is titled “Manopause” but really has little to do with this supposed testosterone “deficiency” condition. The article is mostly about the growing Low-T industry and men’s search to remain youthful. It is more about potential treatments for testosterone deficiency than anything else. Anyone looking for information on what “manopause” is would be misled by the title and would not find any answers in this article. At most, readers learn that men who are worried about aging might have low testosterone. Readers will not gather comprehensive information about manopause, andropause, male menopause, or male aging.

Third, this article only addresses research on testosterone “deficiency” in a cursory manner. Readers looking for actual evidence of decreasing testosterone in midlife or the need for Low-T treatment should make sure to consult scientific studies of such things. Since this is TIME magazine, this is not a source of any real information on these subjects. As another commenter reports, the author’s reference to “foggy science” is also misplaced; while we do not have complete answers, there are real studies to be found on this subject.

Fourth, there are comparisons made to women’s menopause, hormone therapy for women, and how women handle their midlife transitions in this article. While it makes sense to compare endocrinological changes in women’s and men’s bodies and burgeoning hormone replacement industries for midlife women and men, comparisons about how women and men “handle” their midlife transitions are a bit misplaced and subjective here. The author states that “women handle their [bodily] betrayal more matter-of-factly – a nip, a tuck, a tint, maybe, but not a Vegas condo”. The author argues that, “judging by the demographic profile of sports-car buyers,” men don’t deal well with testosterone deficiency and bodily change. As someone who has studied women’s bodies and women’s menopause for almost 20 years, I think this comparison masks the variation in how women or men might experience these transitions and reifies gender dichotomies that help no one in the long run. Women DO have trouble with bodily change at times. And the majority of men still forgo Low-T treatments. The author would have done better if he had steered away from these gendered generalizations about how individuals “handle” midlife.

A commenter at HealthNewsReview.Org asks, Does Manopause Really Warrant one of TIME’s 52 Covers This Year? This is a great question. The power of pharmaceutical industries in this country means that topics like this get more press than is probably warranted (especially in light of all of the topics that could have had this front page, such as Ebola, Ferguson, Parkinson’s or ALS disease, foreign conflicts, etc.). Some scholars argue that we are experiencing the “pharmaceuticalization” of society, which puts industries like the Low-T industry front and center and makes us think in terms of “deficiency”, “disease”, and “replacement”. Pharmaceuticalization reinforces ideas about the importance of youthfulness and unchanging bodies and makes the onset of midlife problematic in general. We are actively urged to fight bodily change (here termed bodily “betrayal”) despite how normal it is.

Lately I’ve also seen a lot of press on men and masculinity. NPR has been running an “All Things Considered” series on boys and men this summer, detailing the hardships and unique experiences that boys and men have. I also read that a group of middle aged men recently got together to create a play called “Four Play” to combat the hype around Menopause: The Musical – to make sure that men have their stage too. In Detroit this summer we’ve also been tangoing with groups of Men’s Rights Activists who feel that feminists are taking over the world. To me, the “Manopause” cover of TIME magazine falls right in line with other recent attention to “men’s issues”. To me, this is all a backlash against attention given to women’s issues. In some cases I don’t even think it’s a conscious or calculated backlash but it still presents as one.

Overall, I’m indifferent about this TIME story. I don’t think it warrants the cover photo or the cover story but it is interesting to find out about a growing testosterone industry. Nonetheless the hype around the story concerns me because I keep thinking about what’s lurking behind the hype. For instance, we have to think about the gendered dynamics behind these stories and media portrayals, for gender forms an important backdrop here and can hinder the pursuit of real knowledge about these midlife transitions. Gender ideologies are what make testosterone (and estrogen) important in the first place. In addition, I do think we need to settle on one term for male menopause/andropause/manopause and why it might be important for us to think about. Finally, we really need to think about what pharmaceuticalization means for all of us.

Footloose and Pharmaceutical-Free?

October 26th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall, Sweetening the Pill

At the West Coast Catalyst Convention for sex-positive sex-educators I was listening to a talk on definitions of sexual health when the birth control pill was brought up. I’d spent much of the event feeling desperately vanilla and so was pleased to be discussing something other than strap-ons and lube. The most popular forms of contraception – the hormonal kind – had been notably absent from all discussion that weekend.

Toys in Babeland window display, Photo by Joaquin Uy // CC 2.0

The speaker told the group that the pill is the leading cause of low libido and pelvic pain. She explained that studies had suggested the impact on libido could be permanent. The reaction of the audience was immediate and urgent – questions were fired out and it became clear that this information was news to most. A number of audience members seemed genuinely shocked. “What’s the science behind that?” one woman asked, but the speaker said she didn’t know.

Although the convention’s attendees had an intimidating level of knowledge when it came to sexual technique and sex toys, I discovered that once I mentioned I was there to develop a book and a documentary on hormonal contraceptives, many repeated the usual disinformation about birth control methods.

The speaker was right – the birth control pill is a leading cause of lowered sexual desire and pelvic pain. It’s also known to cause loss of lubrication, vaginitis, and vulvodynia. Other hormonal contraceptives such as the Depo Provera injection, implant, ring and Mirena IUD have been seen to have similar consequences. In fact, Dr. Andrew Goldstein, director of the U.S.-based Centers for Vulvovaginal Disorders and one of the foremost vulvodynia experts in North America, blames an increase in complaints of this kind on third generation low-dose pills.

The study the speaker referred to was conducted by Dr. Claudia Panzer of Boston University and it did suggest some women may see a permanent effect on their testosterone levels, and so their level of desire. There have also been studies on these methods impact on frequency and intensity of orgasm, showing both to be decreased. Not to mention the 50% of women who will experience general negative mood effects that surely impact on their interest in sex. Many, many other studies have shown a clear negative effect on libido whilst using hormonal contraceptives. So many that it’s become something of a joke to roll eyes over the “irony” of prescribing a pill for pregnancy prevention that stops you wanting to have sex anyway.

At a convention dedicated to the celebration of sexual pleasure, I was surprised to see this information received with such confusion. A sex-positive attitude is becoming synonymous with “set it and forget it” long acting hormonal methods of contraception. But it struck me that sex-positive advocates should be the biggest fans of fertility awareness methods. Here’s why:

Ultrasound Man:Birth Control Superhero

May 17th, 2010 by Laura Wershler

superheroYou know how most superheros become superheros because of exposure to some weird, intensified chemical or element? Take Peter Parker’s spider bite for example.

According to a story reported in various media, including International Planned Parenthood Federation’s website, if science can perfect the contraceptive effect of ultasound on men’s testicles, then we may be in for a new breed of superhero.  Ultrasound Man: able to bear the burden of pregnancy prevention for women everywhere. 

I joke, but for decades women have yearned for gender equality when it comes to bearing the burden of birth control. Could the promise of six months of ultrasound induced, reversible infertility in men be the answer? Well, to date, we only know it works in rats. There is a long way to go before we send the men for a bi-annual ultrasound “zap test”.

This isn’t the first male method touted over the last decade. In 2003, news out of the UK about a birth control pill for men had women nodding their heads with approval. I was immediately dubious and dashed off a commentary for the Calgary Herald that began thus:

Memo to Big Pharma: Save your money. If you think the male birth control pill is going to be a big seller, think again. Memo to women everywhere: Curb your enthusiasm. If you think it’s time men took more responsibility, you’re right — but the Pill for Bill is not going to be it.

Because of the complex hormonal action of the pill for men, I knew it wouldn’t fly. As I noted in my piece:

According to a story from the London Telegraph, because the treatment is invasive, it is likely to be used only by men in long-term relationships. Read it and weep, gals, because this is the wicked truth. It’s OK for women of any age or relationship status to ingest birth control pills or receive the Depo-Provera injection that completely shuts down their reproductive systems, but men would never do the same. It is already postulated that only men in committed relationships are likely to submit to invasive hormonal contraception. That would be supportive husbands and partners of the best kind.

Although a recent  survey by the Family Planning Association found that one third of men would definitely use a birth control pill for men if it became available, I doubt very much, once the mechanism of action were explained (full disclosure), that there would be many takers. I suspect the side effects, and concerns about synthetic testosterone, would result in a pathetic compliance rate.

Certainly the ultrasound method sounds much less invasive. Research leader James Tsuruta of the University of North Carolina said: “We think this could provide men with reliable, low-cost, non-hormonal contraception from a single round of treatment.

Happily, “the team plans to investigate the mechanism that causes temporary infertility.” I think the guys would want to know how and why it works before signing up.  But they can rest assured because Dr. Tsuruta also said: “Establishing safety, efficacy and reversability: these are our top concerns.”

As media stories proliferate documenting the growing trend among young women to eschew the Pill (et. al) in favour of non-hormonal methods, news that there may be a safe, simple method for men on the horizon is both welcome and long overdue.

What I find hard to take, however, is this suggestion expressed by Allan Pacey from the University of Sheffield:

There is certainly a place for an effective non-hormonal contraceptive in men, but whether men would find it acceptable to have their testicles scanned regularly remains to be seen.

Find it acceptable? To have your testicles scanned regularly in a procedure described as “like sitting in a mini hot tub once every six months”?

I dare Mr. Pacey, a lecturer in andrology (the specialty that deals with men’s health) to say this in public to an audience of women who’ve been popping pills (et al) and inserting barrier contraceptives on both their and men’s behalf for the last several years. Ask these women if they find their current method of birth control acceptable. According to the Guttmacher Institute, 4 out of 10 women do NOT find their method of birth control satisfactory. But they take it or use it anyway, at least some of the time.

If ultrasound can safely make contraceptive superheros of men, then men best find it acceptable, and fast.

We’ll just have to wait and see. Thanks to the Bill & Melinda Gates Foundation, the researchers now have $100,000 to prepare a trial for humans. So men, gather up your buddies and get in line for what we’ll call the “team trial”.  Do your bit for contraceptive science. The women in your lives will thank you. 

Oh, but remember, ultrasound birth control won’t protect you or your partner from STI’s.  You still have to use a condom for that protection.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.