Health
Understanding andropause: is male menopause a myth or reality?
During midlife, some men experience troubling symptoms including low sex drive, erectile dysfunction, forgetfulness, irritability, depression and insomnia. Sabrina Rogers-Anderson investigates whether male menopause could be to blame.
By Sabrina Rogers-Anderson
When Steve’s 50th birthday rolled around, he was in no mood to celebrate. He’d been feeling low for months and nothing seemed to motivate him. Even his relationship with his wife had started to deteriorate after nearly 25 years of married bliss.
“I used to have a high sex drive, but it had become almost nonexistent," he says. “I was irritable and short with [my wife] Marcia. She thought I was depressed, but it didn’t feel like that to me. It wasn’t until I finally saw my GP that I was diagnosed with late-onset hypogonadism. I started testosterone replacement therapy and everything got better. I finally felt like myself again.”
While some would say Steve went through andropause or “male menopause”, there’s more to the story than that. Here’s everything you need to know.
Is andropause or ‘male menopause’ a real thing?
“Andropause is a misnomer because there isn’t a definable male menopause like there is with female menopause,” explains Dr Michael Gillman, who has been treating male sexual health issues for more than 25 years.
“Rather than a sudden drop in testosterone like women experience with oestrogen during menopause, it’s a gradual decline. And it’s important to note that it doesn't happen to all men. Some men in their 80s still have high levels of testosterone.”
What causes low testosterone levels in men?
Various medical conditions and lifestyle factors can cause testosterone levels to drop as men age.
“Low testosterone can be caused by a condition known as late-onset hypogonadism, which is also sometimes called androgen deficiency in the ageing male, or ADAM,” says Dr Gillman.
“The area of the brain known as the hypothalamus sends signals to the testes to produce testosterone. If someone's low in testosterone, it could be that the testicles have failed, which is known as primary hypogonadism. It could also be that there's something wrong in the brain and the signals aren’t being sent to the testes to produce testosterone. That’s known as secondary hypogonadism.”
Dr Gillman points to three main lifestyle factors that can cause testosterone levels to plummet:
- Belly fat: “Testosterone may still be produced by the testes, but it’s converted into oestrogen in the visceral fat,” explains Dr Gillman. “That’s why some overweight men develop breasts.”
- Sleep apnoea: This sleep disorder can thwart REM sleep, which is necessary for testosterone production.
- Long-term opioid use: Opioids such as codeine and morphine act on the hypothalamus, pituitary gland and gonads, all of which play an essential role in testosterone production.
While there’s mixed evidence regarding the effects of smoking and alcohol on testosterone levels, adopting a healthy lifestyle will help maintain normal hormone production.
What are the symptoms of low testosterone in men?
“The signs and symptoms of low testosterone are fairly vague and can easily be confused with other conditions,” says Dr Gillman. They may include:
- Reduced muscle mass and strength
- Increase in body fat
- Decreased sexual desire
- Erectile dysfunction
- Bone loss or osteoporosis
- Difficulty concentrating
- Forgetfulness
- Irritability
- Depression
- Insomnia
How is low testosterone diagnosed and treated?
“To make a diagnosis of testosterone deficiency, there needs to be some symptoms and signs, as well as 2 serum testosterone readings in the morning that are lower than 6,” explains Dr Gillman.
If testosterone deficiency is diagnosed, testosterone replacement therapy may be recommended. But Dr Gillman cautions that this isn’t an adequate solution for all men who have low testosterone levels.
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“Most men with low testosterone aren’t truly hypogonadal, but rather their testosterone levels are just on the lower end of normal,” he explains. “They may mistakenly believe that taking [synthetic] testosterone will fix the problem, but it could end up making it worse because it suppresses the body’s natural production of testosterone.
The underlying cause – whether that’s sleep apnoea, visceral obesity or opioids – is what needs to be treated for testosterone to increase, says Dr Gillman. “Unfortunately, many doctors don’t look at it scientifically and prescribe testosterone when it isn’t the right solution.”
Even for men who do have hypogonadism, hormone replacement therapy isn’t enough. “We also recommend lifestyle changes to help get those testosterone levels up,” says Dr Gillman.
When to see your doctor
If you have any signs or symptoms of low testosterone, see your GP. They may give you a blood test to check your testosterone levels, ask you a series of questions and do other tests to rule out any other possible causes such as thyroid issues or depression.
Your GP will let you know what lifestyle changes you should make and whether testosterone replacement therapy is right for you.
In the meantime, eating a healthy diet, exercising regularly and getting enough sleep will help keep your health and hormone production in check.
The information on this page is general information and should not be used to diagnose or treat a health problem or disease. Do not use the information found on this page as a substitute for professional health care advice. Any information you find on this page or on external sites which are linked to on this page should be verified with your professional health care provider.
Feature image: iStock/elenaleonova
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