We've all heard of the menopause when a woman's reproductive function starts to slow down, but do men experience something similar? The term 'male menopause' refers to the physical and emotional changes that some men experience as they get older. It's a surprisingly controversial topic and experts are divided on the subject, with many disagreeing on what it is, how is should be defined, and if it even exists.
But while debate rages on about what to call this life stage, if you're a man in your late forties or older and you experience worrying symptoms including erectile dysfunction, a loss of sex drive, depression, or fatigue, it is worth getting checked out.
We spoke to nutritionist and male hormone expert Roberta Stringer, co-founder of testosterone health brand DNA, and Dr Luke Pratsides, lead GP at Numan, about the male menopause symptoms, causes and treatment options:
What is the male menopause?
The male menopause, also known as andropause – or colloquially as 'manopause' – is a term used to describe a cluster of symptoms associated with an age-related decline in testosterone. Despite the name, male menopause differs substantially from female menopause. Unlike the hormonal drop that occurs in women during this time, sex hormones tend to decrease more gradually in men. Not every man will experience andropause – whereas all women experience menopause – and men can still reproduce, while women can no longer become pregnant naturally.
'Male menopause is the gradual reduction of testosterone specifically related to ageing,' says Dr Pratides. 'It is not strictly a menopause, which specifically refers to the cessation of menstruation in women where ovulation ends and hormone production plummets during a relatively short period of time – instead, it happens over many years.'
Male menopause is not recognised as a medical condition. The term is often used alongside testosterone deficiency syndrome (TDS), which occurs when the testes produce few or no hormones. TDS is characterised by abnormally low testosterone levels (below 300 ng/dL) and has many different causes.
While it's true that many older men experience TDS – approximately 40 per cent of men over the age of 45, according to a study published in the journal Frontiers in Endocrinology, and 50 per cent over the age of 80 – abnormally low testosterone levels are not an inevitable result of ageing.
'Some men still maintain a normal level of testosterone throughout their lives, experience no symptoms and can father children well into their eighties,' says Dr Pratsides. TDS can affect men of any age, but when it occurs later in life, it's known as late-onset hypogonadism or androgen decline in the ageing male (ADAM).
What causes the male menopause?
The symptoms associated with male menopause are attributed to a gradual age-related decease in testosterone levels. 'Testosterone peaks at around the age of 20 in men,' says Stringer. 'Depending on health, diet and lifestyle factors, testosterone levels should remain consistent during men's twenties. They decline steadily from 30 at around one per cent a year.'
While declining T-levels are a given, 'the extent of decline and the age at which this happens varies – even more so with today's lifestyle factors,' she says. The effects appear to be accelerating. One US study identified a 'substantial' drop in the general population since the 1980s, with testosterone levels declining by one per cent per year on average.
Stress, smoking, poor sleep, high body mass index, certain medications, lack of exercise and alcohol are all known to sap testosterone levels. Low T has also been linked to conditions like type 2 diabetes, high cholesterol, high blood pressure, metabolic syndrome and obesity, though it's unclear whether it's a cause or effect.
So, why is male menopause controversial? Some experts suggest that a gradual age-related drop in testosterone is not the primary cause of male menopause symptoms. They believe lifestyle and psychological factors play a far more prominent role. For example, feeling stressed because of problems at work could affect your libido and energy levels.
Symptoms of male menopause
Male menopause is associated with physical, sexual, and psychological symptoms, that tend to emerge slowly and worsen as you grow older. 'Some men notice symptoms from their thirties, others in their sixties, and some – particularly the older generation who were brought up at a time where male hormonal health was not discussed – may not acknowledge any change at all,' says Stringer.
Common male menopause symptoms include:
Reduced sex drive
Increased body fat
Reduced muscle mass
Insomnia or difficulty sleeping
Decreased body hair
Depression or low mood
Lack of motivation
Decreased bone density
If you're experiencing any of the symptoms associated with male menopause or have any concerns, make an appointment with your doctor.
How is male menopause diagnosed?
When you visit your GP they will carry out a detailed check-up based on each of your specific symptoms and address them accordingly. They will also make sure to exclude other medical issues with relevant scans or tests as required.
Your doctor might ask about your personal life to determine whether other factors, such as stress or anxiety, play a part. They may also take a sample of your blood to test your testosterone levels. This will likely take place early or mid-morning, since your testosterone levels fluctuate though the day. A level of less than seven indicates low testosterone. Between seven and 14 is borderline, so further tests may be needed.
Can male menopause be treated?
Some male menopause symptoms can be treated with hormone replacement therapy if your testosterone levels are found to be low. 'Testosterone replacement can be given in gels, patches, or injections,' says Dr Pratsides. 'It should always be guided by a suitably qualified clinician and obtained from a regulated provider.'
Testosterone treatment has various risks and side effects, including acne, worsened prostate cancer, enlarged breasts, disturbed breathing while sleeping (sleep apnea) and high red blood cell counts, which increases your risk of forming a blood clot. Men using testosterone therapy long-term appear to have a higher risk of heart disease.
If your symptoms are attributed to a combination of physical, lifestyle, and psychological factors, your doctor may adopt a more holistic approach. 'Symptoms of low testosterone due to advancing age can be treated individually,' says Dr Pratsides, 'for example, Viagra to help treat erectile dysfunction, or counselling to treat low mood.'
The simplest way to manage symptoms of male menopause is by making healthier lifestyle choices. Eating a well-balanced diet, making time for regular exercise, getting enough enough sleep, reducing your stress levels, and minimising alcohol and tobacco use are all recommended.
How to boost testosterone naturally
Hormone therapy isn't the only way to give your testosterone reserves a boost. Here are four evidence-based ways to increase your testosterone levels naturally:
🔹 Watch out for nutrient deficiencies
Optimise your diet with a balance of carbs, healthy fats and protein. And don't forget the micronutrients. 'Nutrient deficiencies are increasingly common and can cause significant issues for maintaining positive testosterone levels,' says Stringer. B vitamins and zinc are particularly potent, improving sperm quality by 74 per cent in one study. 'Increasing your magnesium intake can raise testosterone levels within a month,' she adds.
🔹 Avoid alcohol
Keep your favourite tipple for special occasions. 'Alcohol directly inhibits the production of testosterone in your testes,' says Stringer. 'It can also impact sleep – as testosterone levels replenish overnight, this in turn can further impact levels.' Getting five hours a night can slash your T-levels by as much as 15 per cent, the University of Chicago Medical Centre found.
🔹 Watch your weight
Maintain a healthy weight and pay attention to body fat levels, says Stringer. 'Obesity has a direct and negative impact on testosterone levels,' she explains. 'Fat cells metabolise testosterone to oestrogen, lowering testosterone levels. Also, obesity reduces levels of sex hormone binding globulin (SHBG), a protein that carries testosterone in the blood. Less SHBG means less testosterone.'
🔹 Get moving
If you don't have a workout routine, now's the time to start. 'A 2004 study of older men found that regular physical activity increased testosterone and growth hormone (GH) levels as well as have a positive effect on brain function,' says Stringer. 'Resistance training has shown to be particularly beneficial for testosterone levels.'
Last updated: 28-01-2020
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