Wait, Male Menopause?!

Introduction

Testosterone production in men reaches a peak in the early 30s, and after that, it starts falling gradually. Many experts believe that after the 30s, there is an annual decline of about 1% in testosterone levels each year. However, unlike in women, men never undergo the complete arrest of gonadal function.

Since most men do not undergo the complete arrest of gonadal function or loss of sperm production, andropause is challenging to describe, and it is wrong to compare it with menopause.

The truth is that most men have considerable sperm production even at the age of 75, and they still have about 65% testosterone level, compared to the peak at a young age.

So, what is really andropause? And what are its signs and symptoms?

Word andropause is derived from Greek, in which “Andras” means male and “pause” is cessation. It is a syndrome characterized by declining sexual function and many other physical signs and symptoms.

Some of the signs of andropause are symptoms like fatigue, a significant decline in libido (low sex drive), nervousness, reduced potency, depression, memory issues, sleep disturbances, and even hot flushes.

However, identifying andropause is not that simple. As one can see, the above signs and symptoms are non-specific, and they occur in a range of health conditions.

Another big challenge with the diagnosis of the condition is that, unlike menopause, it is not a timed process. It generally starts very slowly and progresses gradually over the years. It means that many of its symptoms are pretty mild in their early stages. And, this early stage may continue for years.

Since it has a gradual onset and may not affect all men, some researchers have proposed other terms to define the condition, like late-onset hypogonadism (LOH) or androgen decline in aging males (ADAM).

Things are further complicated because measuring testosterone levels in men is quite challenging. There are significant daily changes in the level of hormones in men during the day. In addition, testosterone levels highly depend on circadian rhythm. Moreover, testosterone is secreted in pulses. All this means that even if a test shows low testosterone for the age, it may not necessarily indicate andropause, as the next test may show normal testosterone levels.

Adding to this challenge is another issue that not all men develop symptoms of low testosterone. It is due to differences in individual sensitivities towards the hormone. Thus, many men are able to maintain sexual function and may have close to normal sperm count, despite quite a low testosterone level.

How is andropause diagnosed?

Most experts agree that there are two ways of diagnosing andropause, one is solely based on symptoms, and another way is measuring testosterone levels in the blood. Perhaps assessing signs and symptoms is a more reliable way among these two methods.

Thus, a middle-aged man may be diagnosing andropause if living with symptoms like low sex drive, sexual dysfunction, fatigue, low bone mineral density, reduced muscle strength, erectile dysfunction, a depressed mood.

The second way could be measuring testosterone in the blood. If a person has testosterone below 300 ng/dl and some symptoms, it indicates andropause.

However, it is vital to understand that doctors would need to exclude secondary hypogonadism caused due to substance abuse, alcohol use disorder, or certain medications.

Why is it important to see a doctor?

As one can see from the description above, unlike menopause, andropause is challenging to diagnose. Women can readily identify signs of menopause. However, it is almost impossible for men to identify symptoms of andropause confidently. Thus, the only way to diagnose the condition is by consulting a medical specialist.

Moreover, it is worth understanding that prolonged and untreated andropause may significantly harm health. For example, advanced osteoporosis, changes in body composition, weakened muscles, low sex drive, or erectile dysfunction are challenging to treat in the later stages. Moreover, treatment of many of these conditions requires a complex approach, use of multiple medications, and testosterone replacement therapy.