男性"更年期"是真實存在的嗎？｜《經濟學人》

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文章探討了男性更年期這一備受爭議的話題。更年期在女性中表現為潮熱、失眠等症狀，且意味著生育能力的喪失，而男性通常被認為可以一直保持生育能力到老年。不過，男性在中年開始睾酮水平會溫和下降，每年約 1%，但與女性更年期的激素急劇下降不同。一些所謂的男性更年期症狀，如疲勞、肌肉萎縮等，可能源於中年生活現實，如工作壓力、久坐缺乏鍛鍊等。

儘管如此，越來越多的男性接受睾酮替代療法（TRT）來緩解類似症狀，該療法在過去 20 年裡處方量急劇增加，但目前對於男性何時真正需要這種療法尚無明確共識。睾酮替代療法能讓男性長肌肉、減脂肪、更快恢復鍛鍊，但副作用可能包括禿頂和不育，接受該療法的男性可能會無意中複製女性更年期的典型特徵。

Is the "manopause" real?

"更年期"是真實存在的嗎？

If it is, it is nothing like the female version

如果是的話，它和女性版完全不一樣

Hot flushes; insomnia; joint pains; loss of libido: for many women, the menopause is no fun. Why exactly women become infertile decades before they die is a much-debated mystery in evolutionary biology. Besides humans, the only other mammals whose females experience so early a menopause in the wild seem to be some species of whale.

潮熱；失眠；關節痛；性慾減退：對於許多女性來說，更年期可不是什麼好受的事。女性為何會在離死亡還有幾十年的時候就變得不育，這在進化生物學中是一個備受爭議的謎團。除了人類，似乎只有少數鯨魚類哺乳動物的雌性在野外會經歷如此早的更年期。

But equal opportunity is the spirit of the age. These days health influencers, supplement companies and even some doctors talk about a male version of the menopause—variously called the “manopause”, “andropause”, or, for acronym-lovers, “ADAM”, which stands for “androgendeficiency in the ageing male”. Symptoms include a flagging libido, tiredness, shrinking muscles and growing body fat.

但平等機會才是當下的精神。如今，健康達人、保健品公司甚至一些醫生都在談論男性更年期——它有各種叫法，如“manopause”（男性更年期）、“andropause”（男性更年期），或者對於喜歡縮寫的人來說，叫“ADAM”，即“androgen deficiency in the ageing male”（老年男性雄激素缺乏症）。症狀包括性慾減退、疲勞、肌肉萎縮和體重增加。

Do men really suffer from menopause, or something like it? On one level, obviously not. Menopause is defined by the end of a woman’s menstrual periods, and therefore the loss of her ability to reproduce, usually by her early 50s. Men, by contrast, can stay fertile well into old age. (For instance, Al Pacino, an American actor, fathered a child at 83.)

男性真的會經歷更年期，或者類似的情況嗎？在某種程度上，顯然不會。更年期是通過女性月經周期的結束來定義的，因此也意味著她失去了生育能力，通常是在 50 多歲的時候。相比之下，男性可以一直保持生育能力直到老年。（例如，美國演員阿爾·帕西諾在 83 歲時有了一個孩子。）

In menopause, a woman’s levels of the sex hormones oestrogen and progesterone fall sharply and suddenly. In most men levels of testosterone (the main male sex hormone) likewise start falling during middle age. But unlike in women there is no sudden drop. Levels decline gently, at a rate of around 1% a year, and often stay within the normal range for a man’s entire life.

在更年期，女性的性激素雌激素和孕激素水平會急劇且突然下降。在大多數男性中，主要男性性激素睾酮的水平同樣會在中年開始下降。但與女性不同的是，男性並沒有突然的下降。睾酮水平溫和下降，每年大約下降1%，並且通常在男性的一生中都保持在正常範圍內。

Sometimes symptoms that might be ascribed to a manopause may arise from the realities of middle-aged life. Tiredness is a common result of juggling work with family responsibilities. Flabbiness and atrophying muscles are the wages of years of sedentary office work and too little exercise.

有時，可能被歸因於男性更年期的症狀，可能源於中年生活的現實。疲倦通常是工作與家庭責任兼顧的常見結果。鬆軟和肌肉萎縮是多年久坐辦公室工作和缺乏鍛鍊的代價。

That being said, some proportion of men do suffer from male hypogonadism, a medical condition in which the testicles do not produce as much testosterone as they should. Estimates of its prevalence vary widely: one review paper, published in 2020, cited one American study of ageing men that estimated 20% of those in their 60s might be sufferers. But a separate European study put the figure for the same age group at just 3.2%. The causes of hypogonadism are not always clear (though obesity seems not to help). But unlike the female menopause, it is not an inevitable consequence of ageing.

話雖如此，但仍有部分男性確實患有男性性腺功能減退症，這是一種睾丸不能產生足夠睾酮的病症。關於其患病率的估計差異很大：2020年發表的一篇綜述論文引用了一項美國關於老年男性的研究，估計60多歲的男性中有20%可能是患者。然而，另一項獨立的歐洲研究將同一年齡組的患病率定為僅為3.2%。性腺功能減退症的原因並不總是明確的（儘管肥胖似乎沒有幫助）。但與女性更年期不同，它並不是衰老的必然結果。

Menopausal women can be treated with hormone-replacement therapy (HRT). This aims to replace the missing sex hormones, and thus relieve unpleasant symptoms, using tablets or gels. Similarly, a growing number of men take testosterone-replacement therapy (TRT) to the same ends. Prescriptions have boomed in the past 20 years, though there is not yet a firm consensus on when men actually need it.

更年期的女性可以通過激素替代療法（HRT）進行治療。這種方法旨在通過使用藥片或凝膠來補充缺失的性激素，從而緩解令人不快的症狀。同樣，越來越多的男性為了同樣的目的接受睾酮替代療法（TRT）。在過去20年裡，這類處方藥的使用量急劇增加，儘管目前對於男性何時真正需要這種療法還沒有明確的共識。

Still, testosterone—the original anabolic steroid—really is, in some ways, a fountain of youth. Men taking it will put on muscle, lose fat and recover faster from exercise (hence why taking testosterone is considered doping in most sports). The pros and cons of TRT are a subject for another article. But take care: side-effects can include baldness and, ironically, infertility. Add external testosterone and the body will compensate by making less. Reduced production in the testes can slow or even stop sperm production. By trying to relieve the symptoms of the supposed male menopause, men who take TRT risk replicating the defining feature of the female original.

然而，睾酮——最初的合成類固醇——在某些方面確實是一種青春之泉。服用睾酮的男性會長肌肉、減脂肪，並且從鍛鍊中恢復得更快（這就是為什麼在大多數運動中，服用睾酮被視為興奮劑的原因）。睾酮替代療法（TRT）的利弊是另一個話題。但要小心：副作用可能包括禿頂和諷刺的是，不育。加入外源性睾酮，身體會通過減少自身睾酮的產生來補償。睾丸中睾酮產量的減少可能會減緩甚至停止精子的產生。通過試圖緩解所謂的男性更年期的症狀，接受睾酮替代療法的男性可能會無意中複製女性更年期的典型特徵。 (Chris的外刊閱讀筆記)