About once a month, for the past few years, I’ve noticed an unusual pattern develop among some of my young male patients. The reason why I hadn’t noticed it until recently was because the details came to me in fragments—like the many pieces of a complex puzzle.  Furthermore, since I had no complete picture or any clinical precepts as points of reference, the pattern remained as is: disjointed and nonsensical. That is until I began putting these pieces together in a whole new way. Once I did that all the pieces came together naturally, and in very unexpected ways. Eventually, what I saw was a picture of your typical young male in their early 20’s, experiencing the common symptoms of...you guessed it, menopause.
 
Understanding Menopause Without Women
 
If you’re like most people, I’m sure it takes more than sheer imagination to picture menopause without women—let alone juxtapose young men in their early 20s with this very non-male condition.
 
Just like you, prior to seeing the whole picture, I couldn’t picture it either. So when my young male patients would complain of what seemed like the common symptoms of menopause (chronic fatigue, iradic mood-swings, irritability, insomnia, poor sleep,  nightsweats, hotflashes, and weight gain), I would only see it for what it was and not what it could be. To me these symptoms seemed, although unusual, not wholly impossible manifestations of common ENT problems like sinusitis, or chronic cough. However, after seeing them time and time again amongst many of my young male patients, and especially after I realized that these men were not getting any better from the typical dietary and pharmacological regiments I prescribed, I started to wonder if there was something else, another piece of this puzzle that I was not seeing. Eventually I realized that menopause was this one piece but there were a couple more I needed to fit together.  But before I can explain what those are in greater detail, I think a basic review of menopause is in order.
 
Understanding Menopause Without Men
 
It goes without saying that women have issues related to reproductive physiology that vastly differ from men as they undergo menopause.
 
As you know, menopause is the process in which women lose estrogen and progesterone production over months to years in their mid-life as their reproductive functions slowly diminish. As this process unfolds many women undergo some dramatic changes.
 
For one thing, with the decreased estrogen and progesterone levels, women’s cardiovascular complications increase. In fact, once women get past menopause, their incidence of heart disease catches up closely with those of men. One of the many explanations is that female hormones may in fact protect women from heart disease.
 
Another change that occurs at this time is that post-menopausal women tend to gain some weight. Again, the theory is that the fluctuating hormone levels decrease their metabolism and as a result make them more susceptible to weight gain.
 
Lastly, and this is what I believe to be the change that trumps all other changes listed above, during this transitional phase, most women lose their airway patency associated with higher estrogen and progesterone levels. As a result, if they already have narrow airways to begin with, they will be more likely to experience many of the common involuntary nervous system responses to a slackened airway during sleep. These include fatigue, poor sleep, night sweats, hot flashes and mood irritability.
 
But again, why are young men in their early 20s, who don’t experience such hormonal fluctuations, still experiencing the very same symptoms that women in their late 50s experience if they’re not going through menopause? The only natural corollary between the two lies in their airways.
 
Menopause Via the Airway
 
Basically, most men do not experience the massive hormonal changes that women do as they age (although is has recently been challenged). As a result, however, most men also miss out on the many added benefits that these female hormones like estrogen and progesterone provide their direct counterparts. The most important benefit being that these two hormones tend to give women’s airway more resilience and patency than men. 
 
Historically, we've known that when estrogen is administered to men it can lower the severity of one common airway problem known as obstructive sleep apnea (as well as heart disease).
 
Along these lines, a recent study also revealed that tongue muscle activity during wakefulness was much lower in post-menopausal women compared with pre-menopausal women. Eight of these post-menopausal women were given conventional hormone replacement, and their tongue muscle activity increased significantly. The study therefore concluded that estrogen and progesterone are thought to play a synergistic role in maintaining upper airway patency.
 
Now, most of you are probably not all that impressed with airway patency mostly because it’s something we all take for granted. Think about it. If right now, your airway was closed off, you would not be reading this newsletter, let alone be thinking: “Is my airway open?”
 
But in all seriousness, if you have the type of narrow airway that a lot of my young male as well as young female patients have, any impedance to respiration can have major detrimental health consequences. This is because a compromised airway often means compromised sleep (think back on how well you slept the last time you had a bad cold with a stuffed up nose). And just as your body would draw up its last reserves of fat and then muscle to keep you alive if you hadn’t eaten beyond 30-40 days (basically cannibalizing itself), think how your body would react if you hadn’t slept well for days, if not for months or even years. Not only would you have an involuntary nervous system in constant overdrive trying to compensate (a stress response), you’d have at the least one very tired, grumpy, and irritable person. At worst, you’d start feeling the effects of a “systems failure”: feeling light headed, in a fog, not able to concentrate, and even
suffering from hot-flashes, and night-sweats. As such, you could be a young healthy male who exercises, eats right and sleeps 8-10 hours a day, and still feel like a 50 year old women suffering from menopause.
 
Now, young women who have the same narrowed airway anatomy are susceptible to these same problems as well. In fact I see many young female patients who suffer from sleep apnea. However, these women have an advantage over men in that, as I’ve mentioned before, their estrogen and progesterone production keep their airways more patent.
 
But men, on the other hand don’t have as much buffers. Therefore, even a slight narrowing of the airway, coupled with a “trigger” like  weight gain, intense stress, bad cold or infection, or even something seemingly unrelated as a shoulder injury which forces them to sleep on their back (when they usually like to sleep on the side) can set them back significantly.
 
It can takes months or even years for both men and women’s bodies to adjust to these changes, and eventually, once the hormonal levels or weight gain stabilize, the symptoms begin to dissipate.
 
So now that the picture is complete, where does this leave us? Perhaps I will describe it in another issue. However, I thought I’d leave you with this to ponder on: That the human body is an amazingly complex matrix—requiring much more than just food and drink. Without attending to its every need and complexity, you’re only seeing disparate pieces of a complex puzzle.
 
 
 
 

West Side ENT