Although it's a complete misnomer, the term "male menopause" has begun gaining ground in popular culture over the last few years. Since menopause comes from the Latin "mensis" referring to month and is tied to the ending of the menstrual cycle, men cannot physiologically go through male menopause. However, the term instantly connotes a physical change of life that is something more than the typical "midlife crisis" often associated with men. Endocrinologist Dr. Adrian S. Dobs is a professor of medicine and oncology for Johns Hopkins University School of Medicine and an active researcher in the field of sex hormone disorders. While she deplores the term "male menopause," she readily admits perfect terminology is still lacking for the condition in which men face physical symptoms due to a hormonal decline, most notably in testosterone. Aging Male Syndrome, Irritable Male Syndrome, Andropause, ADAM (Androgen Decline in the Aging Male) and late onset hypogonadism have all been used to try to define what happens to some men typically in their mid-40s and 50s. Endocrinologist Dr. Richard F. Spark, director of the steroid research lab at Beth Israel and an associate clinical professor for Harvard Medical School, notes "male menopause" is a term that has evolved mainly as an equal opportunity phrase for aging men and women. "When women go through menopause, their ovaries stop making estrogen — zero," he points out. "When men age, they have no sudden drop in testosterone … it's gradual." He continues, "Women go from normal to zero; men go from normal to below normal." While the continued production of testosterone shields men from the severity of symptoms women often face, the decline can and does have a physiological affect in some men. "There's clearly, clearly a decline in testosterone as men age," says Dobs, "and clearly an increased incidence and prevalence in hypogonadism as men get older when compared to looking at a younger man." Dobs continues medical labs looking at young, healthy males have set the definition of what is a "normal" range of testosterone. She adds that for testosterone production in men, "The peak age is 28, based on large epidemiological data. "With the assumption that testosterone declines, then the question is whether or not this is associated with any physiological effects." She and Spark believe there are. Men who are hypogonadal may present with various symptoms including weakness and fatigue, mild anemia, weight gain, depression, decrease in muscle mass, decrease in bone density and irritability. "One of the tip-offs is usually a lack of sexual function," says Spark. "They have difficulty acquiring and maintaining erection satisfactory for sexual intercourse … this is what usually drives them to pick up the phone." Spark says physicians are often as uncomfortable as patients in discussing sexual function but adds it should be a natural part of the reviewer system when conducting a physical exam. "Go straight down the body," he advises physicians. "When they hit the genital area, they should ask 'do you have any difficulty urinating?'" he continues. "At that point, we encourage doctors to ask about sexual function … if you don't ask men, they won't tell you." Spark adds that while sexual dysfunction may be a clear symptom for some men, others may notice a much more subtle decline in the libido and adopt a begrudging acceptance that they just can't do the things they could when they were a younger. He notes that while these problems may simply be part of the aging process, they may be also be due to low testosterone levels. Both Dobs and Spark use androgen replacement therapy, also known as testosterone replacement therapy (TRT), when warranted. "If a patient has a low testosterone level, there are certainly things we can do," says Spark. He begins by getting an accurate testosterone level coupled with other baseline screenings. "The standard assay is a blood test called the total testosterone level, which is a simple test most any lab can do," says Spark. If patients come back in the below normal range, then they may be candidates for TRT. Since testosterone has been linked to aggravating an enlarged prostate and possibly speeding the spread of prostate cancer, Spark says physicians should order a PSA test and digital rectal exam (DRE) to get a baseline screening before deciding if a patient is a candidate for TRT. To monitor patients, Spark suggests ordering a follow-up PSA and DRE at the six-month point and then yearly thereafter once starting testosterone therapy. Dobs also recommends doing a DEXA (dual energy X-ray absorptiometry) scan to get an accurate bone density measure since low testosterone is associated with osteoporosis in men. Testosterone can be administered in several ways. Injections given every couple of weeks have fallen in popularity as daily gels and patches have come into vogue. "The skin can absorb testosterone and carry it into the blood stream," Spark says. "All of these topical applications work very well." Two of the most common gels are AndroGel® and Testim®, while Androderm® is a testosterone-impregnated patch. Daily application of either the gels or patch is required to maintain normal serum testosterone levels. Once an application is decided upon, Spark and Dobs say physicians should conduct regular follow-ups to ascertain the testosterone level has normalized, symptoms are improving and no adverse reactions are occurring. Physicians should especially be on the lookout for a rise in hemoglobin or hematocrit levels above the normal range, changes in blood pressure, voiding problems and sleep apnea. Other milder risks include a skin reaction to the patch or gel, fluid retention, oily skin and breast tenderness or swelling. Dobs says with TRT sexual function and increased libido will often improve in weeks but notes bone density can take up to two years to improve. Although there is an increase in awareness within the medical field about testosterone replacement therapy and the concept of hormonal changes in men, Dobs says it's still an evolving field with a need for much more research. She adds a large-scale, multi-center study is currently in the planning stages and will hopefully answer lingering questions about the benefits and risks associated with TRT.