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Double Menopause - Table of Contents
About the book Double Menopause
Andropause Survey for men
Meet Dr. Nancy Cetel, MD
Lecture Topics
Frequently asked questions about Menopause and Andropause (male menopause)
Other Resources for finding answers about Menopause and Andropause (male menopause)
Other Books
Contact Dr. Cetel

Frequently Asked Questions

What is Double Menopause? Do men really go through menopause, too?
Double menopause can be double trouble. It's when a man and a woman both go through their change of life, in their own unique ways. Yes, men really go through a change of life, too. Men have their own version of menopause, called andropause or viropause. It is not identical by any means but it is significant and involves their physical being as well as their emotional and psychological selves.

When we think of menopause, we think of hot flashes and night sweats and insomnia. What should we think of with male menopause?
Male menopause is transition time -- changes in libido, mood, energy levels. A sense of getting older -- coming to grips with mortality, being very aware of the physical changes.

In your book, you discuss the truth about anti-aging. What is the difference between the myths and the reality of what anti-aging medicine offers?
There is a lot of "hype" about anti-aging. There are no "miracle cures." Everyone grows older but there are ways of maintaining vitality, health and mental capacity without falling prey to anti-aging hucksters. Often this involves real life-style changes rather than an antidote in pill form.

How can partners identify for themselves potential menopause/andropause (double menopause) danger zones in their relationship, and what are some remedies you would recommend?
Be honest with yourself and each other. Rather than hiding from or denying problems, acknowledge what you might be feeling to yourself and your partner. Allow yourself to be more vulnerable and open to your partner; that's what true intimacy is about. If you withdraw, your partner might take this as rejection and a vicious cycle can ensue. Change old patterns and start doing things together that are fun and refreshing -- "date night," playful surprises -- it's amazing how the element of fun and surprise can energize a relationship. It's better to recharge your own relationship than deal with the pitfalls of an affair.

You talk about the rising divorce rate among many couples who are of the age of menopause and andropause (male menopause). Do you think there is a direct correlation, and how thorough is the evidence of this phenomenon?
There is an absolute correlation, but not necessarily a "double-blind" placebo-controlled scientific study to prove the point. The statistics identify a steady rise in divorce and separation at mid-life. We could almost do a graph illustrating declining hormone levels and rising divorce rates, but that doesn't necessarily imply a dose of hormone is an antidote to divorce. It's not quite that simple.

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What are the primary contributors to this problem?
It's a gimish of physiology, psychology and social parameters. The underlying changes in hormonal levels leads to a type of quicksand for our foundation. Then we start to pile on our emotional frailties that start to pop to the surface big-time at this time of life and then we are surrounded by the social phenomenon of a very youth-oriented society that seeps into the mentality. For some, it's too much to bear and the attitude is, "I'm out of here. It's not me, not my fault. It's her (or his) fault."

Men have a hard enough time discussing their wife's "midlife changes." How can women help their men, especially those who don't easily brooch such personal topics, to discuss male menopause?
The first step is to be aware that your man is undergoing andropausal changes, both physically and emotionally. Some women are fooled into believing the macho front that nothing is happening to him "he is stoic to the end." And then they get the big surprise -- his needs are being met by someone who "understands" or is helping him compensate in a different way. Acknowledge the male menopausal changes in a loving, caring manner; with extra tenderness, love and humor, you'll both grow closer.

What is testosterone therapy for, and what are the contraindications and possible risks for it?
Vitamin T, as I like to call it, is a supplement to augment natural testosterone levels. In a woman, it is helpful to have a "tincture" of T to boost libido, desire, and energy levels. In a man, testosterone can enhance sexual performance and libido as well as diminish the risk for osteoporosis. However, too much of a good thing can have potential risks and side effects. Before an andropausal male would start testosterone therapy, he must have a full physical exam and be certain that there isn't any developing cancer of the prostate. There is concern that testosterone might stimulate prostate tissue growth. Also, a man must be aware of his cholesterol levels and risk for heart disease -- too much Vitamin T could aggravate lipid levels and raise the risk for heart disease. For a woman, an overdose of testosterone could lead to increased facial hair growth, oily skin, and male pattern baldness. And this is not the way a woman would want to relate to her man's problems.

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What are some of the basic signs of the onslaught of female/male menopause that both couples can watch for?
Feeling that your partner is not quite himself or herself -- whether he or she is worried about "growing old" or looking old -- this can manifest itself in different ways. Menopausal men are more prone to increased irritability, both with themselves and their spouse. Women are more prone to depression. Also, energy levels can be affected -- sometimes a vicious cycle ensues -- it takes energy to make energy. If the mental stimulation is lacking, the mood begins to sink and the mind/body connection takes hold. Don't wait for your partner to guess your every need -- be proactive. "Ask not what your partner can do for you, ask what you can do for your partner." The results can be contagious.

What are some basic steps couples can follow to rebuild basic communication and bring intimacy back into their relationship amidst the pressures of midlife change?
Be humble and forgiving. This is not the time to take a dramatic stand and maintain pure righteousness. Chances are, there are some secret hurts that need mending; unspoken slights and deep wounds that can fester. Better to over-forgive than to under-communicate. A little warmth will go a long way now, even if there has been a drought. Most couples are hungrier for affection than they would care to admit. The magic of the gentle touch and the kind word should not be overlooked.

What are the signs a man may be experiencing male menopause/andropause?
Having an undeniable urge to buy a red convertible Corvette, or a Porsche -- of any color! But seriously, menopausal men begin to feel changes in libido; their energy levels decline and erections aren't at full steam. This is definitely frightening, especially if they don't have a clue that it's a universal phenomenon. Like a domino effect, the next thing is feeling a need to prove oneself and some men go for out patient therapy by lusting after younger women. If an andropausal man is frustrated and frightened by the changes in his body and doesn't have a clue, or worse, doesn't have a loving, caring partner, depression and irritability can set in.

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What are the signs of menopause?
Menopause is more than hot flashes. Just as puberty doesn't happen overnight, neither does menopause. There is a transition that can evolve over ten years. Of course, the most noted hallmark is the end of menstruation -- but there are many subtle, and not so subtle changes. For one thing, many women start to experience sleep disturbances, with or without hot flashes. Vaginal dryness, loss of sexual desire, fatigue can start to become more common. It's not surprising that emotions come into play as well. Lack of sleep alone can cause irritability, memory loss, lack of concentration and even depression.

What are the basics both sexes should know about each other's hormonal changes?
The most basic, and most important, is to realize that you both are experiencing physical as well as emotional changes throughout this time frame. Each person has his or her unique experience. Whether they express it or not, the transition (double menopause) is occurring. For the andropausal man, the mind/libido connection is extremely important. For the menoapausal woman it tends to be more comprehensive; women are concerned about their physical selves changing and the mood changes that come along with hot flashes and sleep disturbances. Having a loving, supportive partner through these times is key.

What are some steps each middle-aged individual should take to prevent heart disease?
Prevention of heart disease is actually a life-long quest. But it's never too late to pick up the journey and head in the right direction. Certainly if you are a smoker -- stop! Perhaps it's easier said than done but it's worth seeking professional help to stop the habit, especially if it's a lifelong addiction. Find other ways to relieve stress and reward yourself. Of course exercise and the right diet play an enormous role; these you are capable of modifying. You can't change your genes, but you should be aware of what diseases run in the family. For example, high cholesterol, high blood pressure, diabetes, etc. all can have an impact on heart health and that's why a thorough physical is a worthwhile investment to identify problems and treat them early. We've all heard of people who die suddenly, even as young as in their fifties, from a heart attack and everyone is shocked. Chances are there were some warning signs that weren't picked up on. For those who can avail themselves of it, early detection of coronary artery disease by MRI screening is a new tool for catching underlying plaque build-up, even before symptoms develop.

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What is estrogen therapy? And is it safe?
Estrogen therapy is a form of hormone supplementation given to women who are experiencing typical menopausal symptomatology: hot flashes, vaginal dryness, sleep disturbances. In the past, it had been advocated for osteoporosis prevention, as well as protection against heart disease. There have been some significant and large studies that now suggest certain forms of hormone replacement therapy (estrogen and progestin in combination) are not recommended for all women and may carry more risks than originally anticipated. This is an ongoing analysis and, unfortunately, all the answers are not yet in.

What are some important facts and questions women should know when they go in for a medical appointment to discuss the option of estrogen therapy?
Women should realize that the decision to begin estrogen therapy is not a simple one. There are many factors involved, including individual risks, family history, and your own perspective on how you feel about hormones. So there is no such thing as a "one size fits everyone" type of prescription. Since the decision to use or not to use estrogen is so individualized, it is absolutely essential that the appointment should be made with plenty of time allowed for discussion. It should not be a routine 10-minute time slot appointment. So when you call to set up the appointment make sure you ask for enough time with the doctor, so neither you nor the doctor will feel rushed. Certainly ask about the different options, what are the main reasons you are considering hormone replacement and how long should you remain on it? I would also suggest a trial period with a check back in a few months to make sure whatever the choice is, that it is working the way it should.

There has been a lot of talk these days about progesterone. Why would a woman want to use progesterone cream, and how effective is it? Are there side effects?
Progesterone has been available for a long time and it is truly not a substitute for estrogen. Both of these hormones work in different ways. Progesterone creams have been touted commercially as offering many benefits, and yet there is not a lot of research to substantiate the claims. Also, some of the products that are sold over the counter as containing progesterone in a cream base, when analyzed, are found to have very little active ingredient. So I would be very cautious. There are ways of getting true progesterone creams through compounding pharmacies, but this would be by prescription. Like estrogen, progesterone also carries side effects. For some women it includes acne, bloating, weight gain, fluid retention, and moodiness, to name a few.

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What about the use of progesterone cream for men?
I am not aware of any solid information about that.

In a healthy midlife relationship, what are the realities of sexual intimacy? What expectations should men and women bring to the equation?
Like everything else in a relationship, there is an ebb and flow. There will be times of strong intimacy and other times will be quiet. Expectations should be based on what is comfortable for you as a couple, what feels right between the two of you. I don't recommend using Hollywood as a model.

As a doctor, you have seen your patients going through Double Menopause. As a woman, have you experienced it, and if so, how has it manifested itself in your life?
The entire reason for writing Double Menopause was because so many of my patients and their husbands were going through the crazies together - and unfortunately, they were coming apart as well. I couldn't find any books that tackled this, and one day a patient begged me to write something since she knew that I lectured about the topic. The more I looked in the bookstores and came up empty-handed, the more I realized that my destiny was to write this book. And yes, I can relate personally as well. My husband is a good sport and calls himself the "Poster Boy" for male menopause. We are both in the throws of it (we both turn 50 within two weeks of each other this summer). I am not the only one in the house asking "Is it hot in here or what?" It's delightful to remind him that I know what he's going through - you definitely have to have a sense of humor - especially when your wife uses you as a "living example". He gets back at me though; he loves to remind me that I am the "older woman" - by two weeks! And I keep reminding him, "it's not just your testosterone, baby, it's midlife." So now we are known as Poster Boy and Older Woman - I don't mind being the older woman, as long as there isn't "the other woman."

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How does your husband react to the concept of Double Menopause?
As I mentioned, he's got a great sense of humor and doesn't mind being the "Poster Boy" for male menopause - I know he's even proud of it. He even designed Double Menopause tee shirts, which were very popular at a recent convention. There's no question in his mind that Double Menopause is real - and is here to stay. Dealing with it is the main issue. Because of his support, I have been invited to speak at men's health events - both professional and lay audiences - he is helping to break the "old guard" that "Macho means never having to say you're in midlife." He's spreading the word that change of life is a "guy thing" too. It's not just your testosterone, baby, it's everyone's!

What have you done personally to navigate this tricky period in your relationship? What advice that you give to your patients have you followed?
I believe in practicing what I preach. I haven't killed my husband - yet. There are moments, though... We are definitely experiencing a lot of what I discuss in the book. We are almost empty nesters. There have been major changes in our family dynamics, and I am acutely aware of sensitivities - his and mine. Of course we each maintain the right to be entitled to our moods, but there are limits. Perhaps being more generous with praise and appreciation, offered in a sincere loving manner, and not taking each other for granted (despite all these years) has been some of the best self-advice. Small gestures can blossom into a bountiful return as well. Planning little surprises (like preparing a favorite food, when it's not expected), showing signs of affection (a little mini-massage in the middle of the day can do wonders) and keeping yourself fit and lively all play a role in keeping our relationship healthy and happy.

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