Male Menopause: Is it real?

The term “male menopause” is sometimes used to describe the age-related hormone changes in men. Is male menopause an actual condition? Although the medical community is still debating this question, the answer is probably yes, but it is very different than female menopause and is not well-defined.

In women, ovulation stops and hormone production plummets in a relatively short period of time. In men, however, hormone production declines gradually over a period of many years. Testosterone levels usually begin to drop at age 30 and continue to decline throughout adulthood at about 1 percent per year. Most men in their seventies have at least 40% less testosterone in their body than they did at age 30. However, testosterone levels vary greatly among men. Some men in their eighties have higher testosterone levels than healthy men in their thirties.

Signs and symptoms of male menopause emerge very gradually and often not at all.   Usually, symptoms do not occur until a man reaches his late forties to early fifties. Sometimes men experience depression and emotional symptoms that are similar to female menopause, but typically the symptoms involve physical changes or changes in sexual function.

Although all women experience menopause as they age, only a small percentage of men experience male menopause. Depending on definitions, it is estimated that about 2% – 20% of men have either low levels of testosterone in their blood or experience significant symptoms.

Most medical professionals do not use the term “male menopause”. They prefer to use the terms andropause (andro means male) or androgen deficiency of the aging male. The terms testosterone deficiency syndrome and late-onset male hypogonadism are also used.

How are low testosterone levels diagnosed?

To make a diagnosis, a medical professional will perform a physical exam and ask the patient about his symptoms. He may order diagnostic tests to rule out other possibilities or to determine whether there are any medical problems that may be contributing to the condition. He will then order a series of blood tests which may include several hormone levels, including a blood testosterone level.

What are the symptoms of low testosterone levels?

Many men have low testosterone levels without any signs or symptoms. Other men experience changes in sexual function, including loss of sexual desire, erectile dysfunction, decreased frequency of morning erections, and infertility. In some case, the testes may become smaller.

Low testosterone levels can also cause sleep disturbances such as insomnia or increased drowsiness. Weight gain and other physical changes are possible, including low semen volume, loss of muscle mass, decrease in bone density, swollen or sensitive breasts, and loss of body hair or facial hair. Rarely, men may experience hot flashes and loss of energy.

Depression, moodiness, irritability, lack of self-confidence, reduced concentration span, and memory problems may also be associated with low testosterone levels.

Andropause

Why don’t all men experience symptoms?

Most researchers feel that the symptoms of male menopause are NOT caused merely by the normal decline in testosterone levels associated with age. If this were the case, the symptoms of male menopause would be much more common. It is likely that symptoms are exacerbated by underlying health problems such as heart disease, obesity, high blood pressure, and type 2 diabetes. Lifestyle factors such as lack of exercise, smoking, alcohol consumption, stress, anxiety, and sleep deprivation could also be contributing factors.

Is there a treatment for low testosterone levels?

It is important to note that many of the symptoms associated with male menopause are a normal part of aging and cannot be reversed. However, various treatments have been attempted.

In some cases, healthy lifestyle choices can be very helpful. Especially when a man is overweight or obese, he may be advised to eat a healthy diet and include physical activity in his daily routine. According to a landmark study published in Journal of the American Medical Association in 2004, even losing as little as 5%-10% of your body weight can lead to major improvements in health, including blood pressure, cholesterol levels, insulin sensitivity, and erectile dysfunction. Physical activity can increase the flow of blood to the penis, thereby helping men to get and maintain erections. Another recent study published in 2013 in Fertility and Sterility showed that the testosterone decreases in men as they grow older can be reversed with weight loss.

Other lifestyle changes that may be suggested are getting plenty of sleep, limiting consumption of alcohol and caffeine, drinking lots of water, and managing stress. If depression or anxiety is involved, treatment may include antidepressant medications, behavioral therapy, or both.

In some cases, testosterone replacement therapy may be recommended; however, this treatment is very controversial. For some men, testosterone therapy helps relieve symptoms such as decreased libido, depression, and fatigue. However, for others the benefits aren’t clear and there are possible risks. Testosterone therapy might increase the risk of prostate cancer, diabetes, and stroke. It has also been associated with decreased levels of HDL (“good”) cholesterol. Since many men with low testosterone levels also have cardiovascular problems, this is a potentially hazardous effect.

Testosterone replacement therapy is available in a variety of preparations, including skin patches, capsules, gels, implants, and injections. Many health care providers prefer injections since the formulation is rapidly absorbed into the bloodstream, where it goes to the heart and is then pumped to every cell in the body.   However, injections may cause a roller-coaster effect where blood testosterone levels peak and then return to normal levels. They are also more inconvenient, since they require office visits every couple weeks. Topical therapies provide more uniform blood levels but may not be completely absorbed and may irritate the skin. Capsules are generally discouraged since they can cause liver toxicity.

In 2010, the Endocrine Society published evidence-based guidelines for testosterone replacement therapy in men. Specifically, for men who do not have testicular or pituitary disease, these experts recommend testosterone therapy only for men with extremely low serum testosterone concentrations (<300 ng/dL) who also exhibit symptoms of androgen deficiency.

If you are suffering from symptoms of male menopause, a complete physical examination by your doctor or healthcare provider is essential. In some cases, the symptoms may be a sign of an underlying medical condition. Your doctor can determine if any other conditions are involved and help you decide if there is an appropriate treatment.

References:

1) Male menopause: myth or reality?

Source: Mayo Clinic

2) What is the male menopause?

Source: Medical News Today

3) Menopause male

Source: Cleveland Clinic

4) Male menopause: fact or fiction?

Source: MedicineNet.com

5) Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial

Source: Journal of the American Medical Association

6) Determinants of testosterone recovery after bariatric surgery: is it only a matter of reduction of body mass index?

Source: Fertility and Sterility