It has become clear to me in recent months that there are millions of middle-aged men out there who should be on hormone replacement treatment. This is no idle thought: the future of the planet might well rest on this simple observation.
Through meticulous observation and a few hand-picked case studies it has become apparent to me that male menopause is a silent plague and the underlying cause of a great many problems besetting the world. You might have noticed at dinner parties that female menopause is a real conversation stopper (in fact, it is not much of a between-the-sheets conversation either, but evidence on this is thin so I will not go there). The difference is that in the case of women the issue has been flushed out following decades of debate, experimentation, medical research and a billion-dollar hormone replacement therapy business. Not so with male menopause.
This is problematic for two reasons. First, it is not part of the public discourse, which means it is not likely to be discussed during SuperSport ad breaks, over a beer or while nursing the braai coals. Second, and because of this, it is not recognised as a potential problem and as a result is seriously underdiagnosed.
What this means is that there are millions of men out there who are suffering — and the world is suffering with them because, by and large, they run the world. The top honchos are mostly men, most north of 55. If you do not believe me, take a closer look next time at the photograph of the leaders meeting for the G20 or the G8 or the African Union or the European Union. The women in these pictures stand out like sore thumbs. The problem extends beyond governments: in your spare time page through some annual reports, as I have done, and scan the pictures of the top 10 or 20 of any company. It is not a pretty sight.
The problem, in fact the tragedy, is that these illustrious men do not even know they have a problem, or if they are vaguely aware that they have one, they do not know what it is.
Women are not spared this luxury of ignorance. That is because they are hit by an onslaught of horrible symptoms that are impossible to ignore (hot flushes and night sweats, among them). The other reason women face up to the fact that their hormone levels are plummeting is that there is a massive industry geared to netting them at first blush.
No respectable gynaecologist or doctor blinks twice before offering hormone replacement therapy to women who look as though they might be reaching “the change of life”. You do not even need to ask. This is not particularly surprising, given that the market for hormone replacement therapy doubled between 2000 and 2010 from $3.2-billion to $6.6-billion. And the guys minting it are blue-chip groups, such as Wyeth, Bayer Pharma, Schering, Novartis and Lilly.
Science is still divided on the issue of whether men go through a well-defined menopause or not. It seems pretty obvious to me that the good people with the Bunsen burners need to catch a wake-up call. Solid, unbiased observations suggest that this is a no-brainer and it is time hard science stepped up to the plate.
Though hard to find, a small body of literature is beginning to be built on the subject. This suggests that, like women, menopause in men can set in any time after the age of 45. The hormone to blame, if like me you are into the blame game, is testosterone, which begins a slow but steady decline, mid-century. (On the other hand, women have a cocktail of hormones that start to disappear, which includes oestrogen, testosterone and progesterone.)
Some symptoms can be spotted a mile away. The main one is weight gain — as much as 5kg to 7kg — and mostly around the tummy. Gathering evidence on this has not been hard, though discretion has been necessary. Tell-tale signs are buttons that have been sewn on with heavy-duty thread and belts that you know are there but cannot be seen. But a little bulging around the midriff is the least of our problems. The hormone slump sets off a range of other afflictions, including mental lapses, emotional slumps, mood swings and depression.
Consider for a brief moment what this means: decisions that affect the future of humanity are being made by a bunch of men in a funk. Depression makes people irritable, unreasonable, moody, emotional and ill-tempered. Depression “envelops you with a sort of psychic cloud, numbing you with thoughts that the bleak outlook will never change,” according to the 2003 edition of Menopause for Dummies.
The consequences hardly need to be spelled out. Weighty decisions are being made in vast venues and boardrooms on a daily basis by men suffering from some, if not all, of these afflictions. Ill-tempered and crabby, they are deciding on matters such as: Do we go to war? Do we save the planet? Do we bail out Berlusconi? Do we give our workers a pay rise? Do we pay a dividend?
It is safe to assume that the few women who are part of these decisions, such as Brazil’s Dilma Rousseff, Germany’s Angela Merkel, or the World Bank’s Christine Lagarde, have moved out of the danger zone or are medicating themselves through it. But they are outnumbered by 10 to one by people who have not.
Imagine the instant relief for the world if the problem was addressed. Global markets would recover, profits would soar, poverty would be eliminated, the debt crisis would evaporate and wars would end.
This is not fantasy. There are solutions. For women, doctors recommend lifestyle changes such as a new diet or exercise programme, or medication such as an antidepressant. Many recommend hormone replacement therapy, around which great controversy swirls. This has not stopped it being the treatment of choice for millions of women around the world.
Philosophically speaking, I am with Germaine Greer. In her book, The Change: Women, ageing and the menopause, she argues vehemently against hormone therapy. She posits that pharmaceutical companies use scare tactics about crumbling bones and depression to scare women into taking the drugs. There are also risks associated with hormone therapy that lead me to the conclusion that testosterone replacement therapy might not be the way to go.
There is no shortage of alternatives, all commonly trotted out for women. Shelves are given over to them in large pharmacies, normally strategically placed between the vitamin supplements and the creams-that-stop-wrinkles sections. There you will find St John’s Wort, black cohosh, liquorice root, chaste-berry, dong quai, motherwort or red clover extract. Last but not least, there is seaweed that has the added advantage of being very low in calories and high in mineral content.
Whatever the chosen route, there is a strong case to be made for middle-aged men in power to start popping pills or nibbling on some liquorice root. Or kelp could be served at board-meeting tea breaks. The outcome might make the difference between a doomed planet and a sane one. It has been 100 years since menopause was first thought about. The main reason for this is that women usually died before they got there. With any luck it will not take another 100 years to figure out that we all suffer because men suffer from it, too.