Ageing gracefully as a man

By CARROLL DU CHATEAU

Dr Michael Cresswell is seriously interested in the problems of the ageing male. In the morning Cresswell, 57, can be found at Rotorua or Tauranga Hospitals, dealing with conditions ranging from prostate cancer to urinary tract infections. In the afternoon he runs a private practice with a special interest in the problems of the ageing male.

And after work you'll see him biking through Rotorua's Redwood Forest, or attending a step aerobics class, then munching through platefuls of salmon and sardines, rich in Omega-3 fatty acid, to keep himself youthful.

Cresswell says the andropause, or male menopause, is extremely rare. Much more common are the normal symptoms of ageing, which can be held at bay by exercise and diet.

"There is no doubt that the andropause can occur in some men," he says, "and the symptoms of a severe drop in male hormone levels do include hot flushes, sleeping disorders, irritability, lack of motivation, short-term memory loss, loss of muscle mass and body strength, loss of sexual hair, abdominal obesity, decrease in sexual interest and erectile dysfunction. But none of these are specific to the andropause."

True andropause occurs in less than one per cent of men, he says. "Men whose hormone levels are seriously low are extremely rare." Instead, he says, problems are usually due to things such as thyroid malfunction, late-onset diabetes, depression, lack of fitness, poor diet and other problems of late middle age.

"Even erectile dysfunction is usually not due to testosterone deficiency.

"People who have lost their testicles through disease or accident get great benefit from hormone replacement," he says.

On the other hand, testosterone is ruled out for those who have been either surgically or chemically castrated after treatment for prostate cancer. "In those cases we can't give hormones because that would activate the cancer."

Which brings us to another area of medical concern - the unregulated prescribing of testosterone. "If you give testosterone to men who don't need it there's a chance of activating prostate cancer," says Cresswell. "And if Dr Carruthers treats men without measuring their hormone levels, the man's a charlatan."

There is one area of serious medical controversy that could point to larger numbers of men who are perhaps suffering from some degree of male menopause - the way testosterone levels are measured in a patient's blood.

"It is not enough to just measure testosterone levels," says Cresswell. "We now realise we also need to test the amount of bio-available testosterone - that is, the amount of testosterone that is not bound to other compounds, and therefore available to the body.

"The majority of men have a slow decline in total testosterone but an increase in the amount of bound testosterone. This means there's less bio-available testosterone. We need to measure both."

But Cresswell is convinced that few problems are due to severe drops in testosterone. Unlike the sudden drop in oestrogen in women that triggers menopause, testosterone levels decline gently over decades, giving the body time to adjust.

What Cresswell recommends to minimise the symptoms of ageing sounds, sadly, more like hard work than slapping on a hormone patch. His conclusion - after years of studying his patients and himself - is that a rigorous combination of diet, exercise and drinking, will minimise menopause-like symptoms.

"I recommend any vigorous exercise for an hour a day five to six times a week," he says. "The prevailing theory that 20 minutes of gentle exercise three times a week is enough is nonsense. Choose something you enjoy doing, that takes your mind off the pain, and really push yourself."

Such exercise should be backed by a healthy diet stacked with fruit and vegetables (especially antioxidant-rich broccoli and leafy greens), all set off by foods rich in Omega-3, or supplements, to improve cholesterol levels and heart function.

And the easy part of his regime? A couple of glasses of red wine every day - always remembering that more than four glasses reverse the benefits.