Menopause, only for women? The social construction of menopause as an exclusively female condition

Bioidentical hormones, menopausal women, and the lure of the "natural" in U.S. anti-aging medicine

In 2002, the Women's Health Initiative, a large-scale study of the safety of hormone replacement therapy (HRT) for women conducted in the United States, released results suggesting that use of postmenopausal HRT increased women's risks of stroke and breast cancer. In the years that followed, as rates of HRT prescription fell, another hormonal therapy rose in its wake: bioidentical hormone replacement therapy (BHRT). Anti-aging clinicians, the primary prescribers of BHRT, tout it as a safe and effective alternative to treat menopausal symptoms and, moreover, as a preventative therapy for age-related diseases and ailments. Through in-depth interviews with 31 U.S.-based anti-aging clinicians and 25 female anti-aging patients, we analyze attitudes towards BHRT. We illustrate how these attitudes reveal broader contemporary values, discourses, and discomforts with menopause, aging, and biomedicine. The attraction to and promise of BHRT is rooted in the idea that it is a "natural" therapy. BHRT is given both biomedical and embodied legitimacy by clinicians and patients because of its purported ability to become part of the body's "natural" processes. The normative assumption that "natural" is inherently "good" not only places BHRT beyond reproach, but transforms its use into a health benefit. The clinical approach of anti-aging providers also plays a role by validating patients' embodied experiences and offering a "holistic" solution to their symptoms, which anti-aging patients see as a striking contrast to their experiences with conventional biomedical health care. The perceived virtues of BHRT shed light on the rhetoric of anti-aging medicine and a deeply complicated relationship between conventional biomedicine, hormonal technologies, and women's bodies.

The medicalisation of male menopause in America

The topic of male menopause occupied space on the medical radar screen from the late 1930s through the mid-1950s, then virtually disappeared for the next four decades, until the late 1990s. By contrast, articles on this subject appeared in American popular magazines and newspapers at a consistent, if low-level, rate throughout the same period. This essay describes how the male menopause became medicalised, not by the driving forces of academic researchers and influential clinicians, but instead by a model perpetuated by lay people and medical popularisers. A medicalised conceptualisation of the body and the life-cycle had become widespread by the second half of the twentieth century, as Americans grew accustomed to regarding their lives through the lens of medicine. People came to expect medicine to provide a cure for any ailment; in the wake of the development of the so-called wonder drugs, no affliction seemed beyond medical and pharmaceutical intervention. A medicalised model had also been effectively produced for understanding and treating the menopause in women; a parallel, if not identical, stage in the life-course of men seemed reasonable. This framework, rather than persuasive evidence from the research laboratory or clinic, helped to medicalise male menopause and provided the basis for its eventual pharmaceuticalisation at the end of the twentieth century.

Climacteric symptoms among Japanese women and men: comparison of four symptom checklists

OBJECTIVES

To explore whether Japanese kōnenki (climacteric) symptoms are unique to women or are experienced by men, to compare common symptom indices, and to explore the relationship between symptoms and soy intake.

METHODS

Two-week recall of 54 symptoms, an eight-item food frequency questionnaire, and views about kōnenki were collected from 60 individuals in Kanazawa, Japan. Factor analysis identified kōnenki-associated symptom groupings; Blatt-Kupperman, Simplified Menopausal Index, Lock, and Kanazawa symptom scores were calculated; and sex and kōnenki status differences were tested.

RESULTS

Thirty-two women and 22 men (mean age 48.7 years) provided complete questionnaires. Although males had higher prevalence of stress, irritability, and nervousness (p < 0.05), no men reported having kōnenki. Four of eight female symptom factors exhibited significant correlations with kōnenki status. All symptom index scores were lower in pre-kōnenki women than in peri-kōnenki women, but scores for men and women did not differ. Soy intake and Lock score were negatively correlated among women.

CONCLUSIONS

Several symptoms commonly associated with kōnenki in Japan are not unique to women and have higher prevalence in men. Inclusion of men in climacteric studies may permit identification of male climacteric symptoms and assessment of the specificity of many typical female climacteric symptoms, thus refining and standardizing symptom checklists.