Category: Male Matters

Menopause Isn’t Just A Woman’s Problem: Let’s Talk About LGBTQ+ Health

By Emma Wiltshire, 17th June 2022

Menopause poses multiple problems and concerns for billions of people over the world. It is important that we talk about LGBTQ+ health in relation to menopause and other issues. Being Pride Month, we couldn’t think of a better time to re-spark a true, open conversation.

Our experts have been discussing the struggles that transgender men and non-binary people may face when going through menopause, as well as some of the symptoms and issues they may encounter that differ from those of cis women. It may not seem obvious to many others, but as well as the usual medical symptoms, they are at risk of additional stress and risks associated with menopause.

In light of Pride month, we will also be outlining why people in the LGBTQ+ community may be at risk of different health problems throughout life, and why many struggle to seek or receive proper help for even the most common of issues.

MENopause…

It’s really not just a woman’s problem.

Cisgender (or cis for short) people are those who identify with the sex they were assigned at birth. For example, people who were born female and still identify as female would be known as cisgender women.

Transgender (or trans) people are individuals whose gender identity doesn’t match that of which they were assigned at birth.

Non-binary people are individuals who do not identify as solely male or female and use pronouns other than he/him or she/her. Most commonly they will identify as they/them as they fall outside of the gender binary.

With this in mind, we need to realise that cis women aren’t the only ones who suffer from menopause-related symptoms and issues. Transgender men (who have not fully transitioned) and non-binary individuals will also go through menopause, though it is often overlooked. People producing estrogen and progesterone will start to produce less and less as they get older which is the typical catalyst for menopause.

Also, if a transgender person decides to go through a transition with prescribed testosterone hormones late in life – they may already be of an age where their bodies are naturally going through menopause.

Similarly, for transgender men who do not use hormone therapy at all, their bodies will still be producing the reproductive hormones that trigger menopause in the same way as a typical cis woman.

This can be a difficult time as people will be going through both the usual menopause symptoms as well as any gender dysphoria they may experience at the same time.

Gender dysphoria is the feeling of discomfort or distress that might be caused by a mismatch between a person’s biological sex and gender identity.

For some people, this can be a very minor issue. However, for many, it can have a major impact on their day-to-day lives leading to depression, body dysmorphia and other mental health issues.

With these concerns in mind, different people in the LGBTQ+ community may feel especially uncomfortable with changes to their bodies during menopause, such as weight gain, loss of muscle mass and bone density, hot flushes and night sweats.

Has The Health Industry Caught Up?

The experts are definitely doing more than in previous years. However, many health professionals are still not quite there, unfortunately. The entire health industry still has a long way to go before it can provide adequate care for LGBTQ+ people as a whole.

One of the main issues is that transgender and non-binary people are often misgendered by healthcare professionals. This can be extremely distressing and make it difficult for them to seek help or feel comfortable discussing personal matters with doctors.

There is also a lack of LGBTQ+ inclusive educational materials on menopause and related health problems. This leaves many people feeling lost and without any guidance on how to deal with their symptoms alongside any other related concerns.

What Can Be Done To Help?

There are some steps that both individuals and the medical industry can take to make things better for people going through menopause.

On an individual level, it’s important to be respectful and mindful of everyone’s pronouns and gender identity. If you’re not sure what someone’s pronouns are, just ask! It shows that you care about being inclusive and want to make sure everyone feels comfortable.

If you are someone experiencing menopausal symptoms, don’t suffer in silence! Talk to your doctor about what you’re going through and see what options are available to you. There is no shame in seeking help and you deserve to feel supported during this time.

LGBTQ+ Health & Wellbeing

LGBTQ+ people experience a number of health disparities. They’re at higher risk of certain conditions and are known to have disproportionate access to primary healthcare. This is seen in areas of mental health, physical health, and access to care.

LGBTQ+ people often face higher rates of stress, anxiety, and depression. This can be due to minority stress, which is the result of experiencing prejudice and discrimination. Individuals may also face rejection from family and friends, making it difficult to find a support system.

This lack of social support can lead to risky behaviours, such as using drugs or alcohol as coping mechanisms. These substances can then lead to other health problems down the road.

Young people in the community are, heartbreakingly, especially at risk for obesity, eating disorders, and suicide.

Access To care

Facing the discrimination many know all too well, can also increase the risk of unfair treatment and poor quality care. While we know a huge percentage of the medical industry has made leaps and bounds in this area, those who identify as LGBTQ+ are less likely to:

Have health insurance
Receive timely care
Receive correct and relevant treatments
Understand health disparities that relate to them

This means LGBTQ+ individuals are more likely to forego care altogether. This can result in a number of serious health problems, some of which may be life-threatening.

While some may be able to undergo transitions and seek treatment for serious mental health or physical illnesses – there is still a way to go to make health care accessible for all.

Reproductive Health

While couples that share the same reproductive organs do not need contraception to prevent pregnancy (although contraception is always advised to prevent sexually transmitted diseases), there is still a large proportion of the LGBTQ+ community who want to get pregnant or start a family.

LGBTQ+ people often face unique challenges when trying to conceive. For example, female same-sex couples will need to use donor sperm, which can be found via sperm banks or known sperm donors (such as family members or friends).

Transgender men who haven’t fully transitioned and want to carry their own child will also need to seek fertility treatment options if single or in a relationship with a cis-woman or person with female genitalia.

Despite the challenges, there are a number of resources available for LGBTQ+ people who want to have children. Fertility clinics are LGBTQ+ – inclusive and welcoming (just like ours)!

At The Surrey Park Clinic, we have helped many same-sex couples become proud parents. It is truly a privilege to help create families and we always ensure both partners feel fully involved in the process right from the start. There are various options to consider when starting the fertility process.

Sperm Donors
Intra-Uterine Injections (IUI)
In-Vitro Fertilisation (IVF)
Shared Motherhood

If you’d like a consultation or more information on any of these options, get in touch with our team or visit our dedicated page.

Working Towards A Solution

There’s no denying that the LGBTQ+ community has been, and continues to be, dealt some pretty tough cards when it comes to their health and wellbeing.

But we also know that things are slowly but surely getting better. With more open discussions around LGBTQ+ issues and an increasing number of inclusive policies being put in place, hopefully, we’ll see even more progress in the years to come. In the meantime, let’s all do our part to support our LGBTQ+ family and friends by continuing the conversation and standing up against discrimination.

We are proud to have built The Surrey Park Clinic into a welcoming and inclusive care facility. That is why we advocate for better communication between professionals and patients, allowing people to receive the care they truly need.

Being open and honest is one way people worried about LGBTQ+ health, can help experts deliver a higher standard of care.

Amongst this, we will also be focussing on the continued education of these issues and reaching out to anyone who may be in need of our services. So please, do not hesitate to get in touch for a chat or more information about anything you have read here today.

Can new fertility device improve chances of pregnancy?

By Katie Biddiss, 26th January 2022

Improving Chances of At Home Conception – Is it Possible?

We read with interest about the new Fertility device (Twoplus Fertility Sperm guide) that promises to increase the chances of conception by retaining sperm in the vagina for over an hour. The aim is to prevent sperm leakage after intercourse and create a rich pool of sperm in the vagina, thereby increasing the chances of fertilization by enabling more sperm cells to swim up into the uterine cavity.

The device is inserted into the vagina, and the male ejaculates sperm into the pouch of the device. Manufacturers of this device recommend that couples use a lubricant to minimize the male partner’s discomfort during intercourse.

“Great interest among our patients; including same-sex couples who wish to explore self-insemination.”

Obviously, the development of any device that facilitates conception is always exciting to the Fertility community.

Although we are yet to see any scientific data to back the efficacy of this device, we anticipate that it would draw great interest among our patients; including same-sex couples who wish to explore self-insemination.

Obviously, the outcome of fertility treatment is influenced by various factors, which is why treatment must always be individualized. Each case is different, and it is essential to ensure that the treatment of choice is suitable for the individual patients.

“The outcome of fertility treatment is influenced by various factors.”

Devices like this would be much more effective for women who have a good understanding of their ‘body’.

It is extremely helpful for women to understand the ‘fertile window’ and to aim for insemination/intercourse at the time of optimum fertility.

The fertile window is best defined as the 6day interval ending on the day of ovulation. The viability of both eggs and sperm should be maximum during this time. Research has shown that peak fecundity was observed when intercourse occurred within 2 days before ovulation.

Among women who have regular cycles, the likelihood of conception increases during the putative fertile window.

At home fertility device to help with conception

TwoPlus Fertility Device

Unfortunately, the timing of the fertile window within a given cycle can vary considerably, even in women who have regular cycles. Although fertility tracking methods (including calendars and apps; cervical monitoring, ovulation detection kits and basal body temperature tracking) can help assist patients to understand their own personal cycle characteristics. A major weakness of these predictor devices is that they are based on the assumption that the timing and duration of a woman’s fertile window are consistent and dependent on cycle length characteristics and trends. But we know that cycles are pretty much variable, and the timing of ovulation can vary from month to month and from woman to woman.

The calendar method is based on the length of the menstrual cycle. The length of the luteal phase (the part of the menstrual cycle after ovulation) is presumed to be about 14days. Thus, the day of ovulation would be cycle day 14 for women who have a 28-day cycle and day 16 for women with a 30days cycle.

“Unfortunately, the timing of the fertile window within a given cycle can vary considerably, even in women who have regular cycles.”

The fertile window, therefore, is set as the presumed day of ovulation and the 5 days prior (cycle day 9-14 in a 28 day cycle and cycle days 11-16 in women with a 30 day cycle etc).

Finally, it is important to note that sperm is motile and swims into the cervical canal extremely quickly and shortly after deposition in the vagina. Studies have shown that sperm deposited into the vagina at mid-cycle are found in the fallopian tube within 15 minutes. Sperm has been found in the cervical canal seconds after ejaculation, regardless of the coital position.

Although many women think that lying face upwards for some time after intercourse facilitates sperm transport and prevents leakage of sperm from the vagina, this belief is not backed by any scientific evidence. Lying still in bed or elevating the legs does not necessarily increase the chance to conceive. Motile sperm swims up the genital tract, and some seminal fluid leakage is normal.

Whilst we welcome new devices that help our patients conceive, it is important that the right patient group are identified for each treatment type, and treatment must be individualized.

For more information on the different fertility options available to you at The Surrey Park Clinic, please click here.

Mr Emmanuel Kalu MBBS, DFFP, FRCOG

Consultant Obstetrician and Gynaecologist

Specialist in Reproductive Medicine

Should YOU be using testosterone gel? Experts reveal how to avoid the ‘male menopause’

By ODOllie, 5th February 2016

Peter O’Brien can’t quite remember exactly when he began treatment for his low testosterone.

‘About five months ago,’ he says, waiting for the kettle to boil in the kitchen of his home just outside Bath.

His wife Lucy, however, can tell you precisely when it was. ‘It was February 16,’ she chips in, and they laugh.

She knows for certain because within three days of starting to apply testosterone gel to his skin, her 52-year-old husband, who hadn’t been himself for two years, suddenly rediscovered his interest in sex.

He’s not the only one.

A group of 65-year-old men experienced similar effects when they were given testosterone gel during a year-long study published last month in the Journal of Clinical Endocrinology & Metabolism.

As well as improved libido, the men reported having more frequent sex and night-time erections compared with those who were given a placebo gel.

It’s the kind of research that has men of a certain age asking themselves whether they should be having the treatment, too.

In fact, an improved sex life isn’t the only benefit of restoring testosterone — men with low levels can suffer a range of symptoms, including night sweats, joint pain, muscle loss, irritability, loss of memory and even depression.

Put simply, testosterone deficiency can make a man’s life as much of a misery as the menopause does for many women.

Fortunately, the solution is simple — a daily dose of testosterone, usually administered as a gel rubbed into the skin on the shoulders (where others are unlikely to come into contact with it).

Unfortunately, the medical profession is bitterly divided over who needs it.

The mainstream view is that only a small number of men with specific medical problems really need testosterone treatment — the remainder need to address their lifestyles.

But leading exponents of testosterone treatment say hundreds of thousands of men whose lives could be improved virtually overnight are being left to battle alone.

Even if a man is referred by his GP to a hospital endocrinologist for suspected testosterone deficiency, they say, he is very unlikely to find a sympathetic ear and so many are forced to go private.

IS THE MALE MENOPAUSE A MYTH?

There is no doubt that low testosterone can and does cause multiple problems — the sticking point is how low your testosterone needs to go in order to be treated.

The conventional approach is that only men with a specific medical problem, such as late-onset hypogonadism (LOH), need treatment.

According to the Society for Endocrinology, the organisation that represents hormone specialists, the number of men in the UK affected by LOH ‘is small’, around 2.1 per cent of men aged 40 or over.

The official NHS position echoes this — while acknowledging that a testosterone deficiency ‘can sometimes’ be responsible for symptoms such as loss of libido, mood swings, loss of muscle mass and energy, the NHS says this is actually a rare medical problem.

Furthermore, this kind of testosterone deficiency is certainly not a normal part of ageing (unlike the female menopause).

According to the NHS, while all men do suffer a small reduction in testosterone — less than 2 per cent a year from around the age of 30 to 40 — ‘this is unlikely to cause any problems in itself’.

Far more likely to be responsible for any symptoms, it says, are ‘lifestyle factors’, such as bad diet and lack of exercise — along with ‘psychological problems’, such as the ‘male midlife crisis’.

From this perspective, the so-called male menopause is nothing more than a great marketing tool.

One leading endocrinologist Good Health spoke to went even further.

‘The so-called male menopause doesn’t exist,’ says Richard Quinton, a consultant endocrinologist at Newcastle Hospitals Foundation NHS Trust and a spokesperson for the Society for Endocrinology, the branch of medicine that specialises in hormone imbalances.

‘It’s all commercially driven snake oil.’
But Peter would disagree. The owner of a successful software development company, he had retired early and was looking forward to spending time with his wife but shortly after turning 50 says he began to feel ‘something was wrong’.

It wasn’t, he insists, a reaction to hitting the big five-oh.

‘I really didn’t care about that. But I felt like I was about 70 — run-down, no energy and people who hadn’t seen me for a while said I suddenly looked older.’

He began to worry something was seriously wrong. After a series of blood tests, his doctor told him he was fine, but there was one thing that hadn’t been measured — his testosterone.

Peter had read about testosterone deficiency and asked his doctor whether that could be his problem — ‘but I got the impression he didn’t really want to get involved with that’.

Peter insisted and his testosterone level was measured and he was referred to an NHS endocrinologist.

‘I was told my levels were very low, but that was normal and I should just carry on. But I felt far from normal.’

Frustrated, he went to a private clinic where he was prescribed a daily dose of testosterone. ‘I quickly got my life back,’ he says.

TOO EMBARRASSED TO DISCUSS SEX PROBLEMS

But while Peter is more than happy to tell his story, it was on condition of anonymity. Peter is not his real name.

Like the other men having testosterone treatment who spoke to Good Health, he refused to go public and that, says Dr Clive Morrison, a doctor at the clinic where Peter was treated, is part of the problem preventing many more men benefiting from testosterone.

‘There is no stigma among women about the need for hormone replacement therapy, and consequently the vast majority who need it, get it,’ says Dr Morrison, who works with the Centre for Men’s Health.

‘Unfortunately, the opposite seems to be true for men. Many appear to think there is something almost shameful about even the slightest suggestion that they might benefit from similar treatment, from a similar age, to help correct a similar hormonal deficiency.’

Men ‘are particularly reticent about admitting that their sex drive and bedroom performance might have been compromised’, he says.

As a result, ‘very few of those who need it and could benefit greatly from it actually seek out testosterone therapy, and those who do rarely talk about it, perpetuating the stigma and leading to a significant degree of unnecessary suffering amongst middle-aged and older men’.

As well as stigma, another barrier to hormone treatment for men is whether symptoms alone rather than blood test results are enough.

One of those championing the cause of testosterone treatment is Dr Malcolm Carruthers, who originally trained as a GP and later founded the Centre for Men’s Health.

Dr Carruthers, who freely admits he has ‘wildly diverged’ from the mainstream view for the past 30 years, says that thousands of men in the UK over 50 could benefit from testosterone treatment, but that only 1 per cent of them are getting it.

ARE BLOOD TEST RESULTS MISLEADING?

As evidence, he cites his own clinical experience and research published in a series of papers in the journal The Ageing Male, by Lothar Heinemann, a doctor at the Berlin Centre for Epidemiology and Health Research.

Research by Dr Heinemann and colleagues concluded that in most European countries, as well as Australia, Russia and Japan, 20 per cent of men over 50 could be rated as deficient in testosterone on the basis of their symptoms alone.

Dr Carruthers and others believe that there is over-reliance on blood tests to diagnose low testosterone.

He says the blood tests are so imprecise and the definition of a ‘normal’ level so wide as to be almost meaningless, and that a man’s symptoms alone can usually tell the whole story.

This approach appears to have been vindicated by a paper Dr Carruthers published last year and which was co-authored by researchers at the urology department of University College Hospital, London, and the Alzheimer’s and Ageing Department at Edith Cowan University in Perth, Australia.

The study reported the long-term effects of testosterone therapy on 2,200 men (average age 54) treated at Dr Carruthers’s centre since 1989 and concluded that it was effective and safe.

Significantly many of the men in the study had suffered for between three and five years with symptoms including loss of libido and energy, erectile dysfunction, night sweats, joint pains, depression and irritability, but had been denied treatment by their doctors because blood tests had shown their testosterone levels to be ‘in the “normal” range’.

Another advocate of testosterone treatment is Dr Erika Schwartz, a U.S. doctor and author of the best-selling book The Hormone Solution. She argues that men ‘need help with hormones just as much as women do’.

‘The male menopause has never been in the spotlight because men who experience it have been reluctant to acknowledge its existence [and] the medical profession has not been keen to address this obvious similarity to female menopause’.

She told Good Health: ‘Almost every day I see 60-year-olds who tell me testosterone therapy is magical and they’ve got their lives back.’

Her own husband, Ken Chandler, now in his mid-60s and an executive editor of a U.S. news website, has testosterone treatment.

‘It has made me livelier. I think I look better than I did at 50 and I have much more energy and focus. And it’s certainly improved my sex drive,’ he told Good Health.

IS YOUR MAN BORING AND FLABBY?

The tragedy, says Dr Schwartz, is that the solution is so easy — a daily dose of testosterone — but ‘unfortunately men have certain ego issues and they see male menopause as a failure instead of another stage in life’.

‘All you have to do is look at most men in their 50s and 60s, and how they look will tell you where they stand hormonally: they are overweight, their eyes are no longer shining, they’re not interested or interesting, they are boring and depressed and they have flab not muscle.’

All this, she says, is too readily dismissed by many in the medical profession as ‘just part of the ageing process — but what if they’re wrong and you can do something about it, and the solution is having your hormones balanced and taking care of yourself?’

That view is heresy to mainstream medics.

And yet things do seem to be changing. The latest figures for NHS prescriptions dispensed in England showed there were over 201,000 issued for testosterone in 2015, up more than 200 per cent from the 65,000 ten years earlier.

So it seems some men are being helped.

But this increasing use of hormone therapy has been condemned as ‘an epidemic of testosterone prescribing’ in a paper co-authored by Richard Quinton and published in the journal Clinical Endocrinology in 2013.

‘Many men in the UK might be receiving testosterone replacement therapy with neither clearly established indications, nor robustly diagnosed hypogonadism,’ it said. In other words, some men receiving the treatment should not be.

They laid the blame primarily at the door of an increase in online advertising by U.S. pharmaceutical companies designed to create the impression that testosterone deficiency is common in older men.

It would not, Dr Quinton told Good Health, be unreasonable for a man with symptoms suggestive of testosterone deficiency to ask his GP for a blood test.

But he insists: ‘Only 2 per cent of older men actually have something that is similar to a menopause, where their testes begin to function less efficiently and they produce less testosterone and less sperm.

I say “similar to” because in the menopause the ovaries just shut down completely and produce no hormones, whereas in these men the testes begin to function less efficiently.’

With medical opinion so widely divided, men could be forgiven for being confused about what to do for the best.

Two years ago, reseachers at 12 centres across the U.S, funded by the National Institutes of Health, set out to settle the question once and for all, with a series of seven studies on testosterone treatment in older men, known as the Testosterone Trials.

The study published last month looking at the 65-year-olds’ libido was one of the seven.

By Jonathan Gornall For The Daily Mail