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Heard of "male menopause"? It's a term that's heavily used in the media to describe the drop in testosterone levels as men get older. Also known as the "andropause," it's garnered significant attention online. Some men notice low mood, loss of sex drive, erectile dysfunction, and other emotional and physical symptoms in their late 40s and early 50s.
However, the term "male menopause" is somewhat unhelpful. Unlike female menopause, when there is a sudden hormonal change, testosterone levels decline slowly in men at around 1% per year from the age of 30 onwards.
In this guide:
Symptoms Commonly Attributed to "Male Menopause"
The gradual decline in testosterone can lead to symptoms in men in their late 40s and early 50s(1). These male menopause symptoms cover physical, psychological, and emotional aspects of life.
Look for these andropause symptoms:
Physical Symptoms
Fatigue
Reduced muscle mass and strength
Decreased libido and erectile issues
Increased body fat
Gynaecomastia or breast development
Insomnia or difficulty sleeping
Infertility
Decreased testicular size
Reduced body hair
Hot flushes and sweating
Psychological Symptoms
Difficulty concentrating
Memory issues
Reduced motivation
Emotional Symptoms
Irritability
Low mood or mild depression
Anxiety
Factors Contributing to Male Menopause Symptoms
Remember, these male menopause symptoms are linked to several conditions. Everything from your diet to your lifestyle can cause low mood, decreased muscle mass, and even erectile dysfunction. It's important to consider all facets of your life. Consider these lifestyle factors:
Depression: Low mood and lack of motivation can intensify symptoms.
Stress: Chronic stress impacts hormone balance and overall well-being.
Poor Diet: Inadequate nutrition can lead to fatigue, weight gain, and mood changes.
Poor Sleep: Sleep deprivation exacerbates fatigue, irritability, and cognitive issues.
Anxiety: Heightened anxiety may worsen concentration and emotional stability.
Smoking: Smoking affects blood flow and hormone levels, potentially reducing libido and energy.
Alcohol: Excessive alcohol intake can impair hormone production and mood stability.
Counteracting these factors and getting your lifestyle in order can go a long way to rectifying the issues associated with andropause. In fact, several of these factors, e.g., poor sleep, alcohol, smoking, and stress, can contribute to low testosterone.
Myth vs. Reality: Is the "Male Menopause" a Real Condition?
When women approach menopause, their egg supply diminishes, triggering significant hormonal shifts leading up to the final menstrual period. This perimenopausal phase brings sudden, sometimes intense hormonal fluctuations lasting several years. In men, there's no direct equivalent to this process.
Is Male Menopause a Myth?
Some medical professionals have labelled "male menopause" or "andropause" as a myth. There's no doubt that men do not experience the sudden onset of symptoms in the same manner as women. After all, there is no male equivalent to the menstrual cycle. Dismissing the term out of hand, however, ignores the underlying phenomenon that men experience.
The gradual decline in male sex hormone levels is real. Low testosterone in men (or androgen decline in the ageing male (ADAM)) is noted in men older than 50 years. It's associated with fatigue, depression, decreased libido, erectile dysfunction, and changes in mood and cognition(2).
In fact, in one analysis(3), elderly males who were depressed had the lowest testosterone levels compared to their peers. Testosterone levels have declined in men for several decades. This decline isn't linked to health and lifestyle factors such as smoking or obesity(4). With each generation of men having lower levels than the last, it may be that, combined with age-related decline, some men experience considerable symptoms in their old age. However, research into this phenomenon is lacking.
Understanding and Management Andropause
While the decline in testosterone may be gradual rather than sudden, its impact on men's health and quality of life can be significant. Symptoms such as decreased energy, mood swings, and reduced libido can accumulate and create noticeable changes, particularly for men who are not aware of the cause.
Understanding that these symptoms can stem from hormonal shifts rather than merely ageing can help men seek appropriate support, whether through lifestyle adjustments, medical interventions, or hormone replacement therapy where suitable.
The term "male menopause" may be misleading, but it's become a useful way to highlight the challenges men face as they age. The problems of low testosterone in men aren't permanent. With new hormonal treatments available, such as hormone replacement therapy, counteracting andropause symptoms is a viable solution. Rather than dismissing male menopause as a myth, acknowledging and studying the phenomenon could lead to better health outcomes for men in midlife and beyond – even if a new name is required.
What to Do If You're Experiencing "Male Menopause" Symptoms?
Talk to a Professional
If you're experiencing male menopause symptoms, it's important to speak to your doctor. These symptoms are associated with several other conditions. You may need a thorough assessment to determine the underlying cause.
For example, some men experience late-onset hypogonadism, characterised by very low testosterone levels in older men. But the symptoms may be due to hypothyroidism, metabolic syndrome, medications, lifestyle factors, work-related stress, and much more.
Speaking to a medical professional can help you sort out what's going wrong and what you need to do about it. Your doctor may perform a physical examination of testicles, hair growth, and any gynaecomastia.
Take a Testosterone Test
Andropause is closely linked to testosterone levels. Taking a testosterone test can determine if you've got healthy levels or not. It measures the testosterone attached to proteins (attached testosterone) and the rest (free testosterone). It's sometimes included as part of a "Well-Man Check".
Alongside a testosterone blood test, other potential tests include5:
Luteinising Hormone (LH): This hormone, a precursor to testosterone, helps doctors assess the causes of low testosterone levels. Pituitary gland issues can affect LH levels in the blood, impacting testosterone production.
Prolactin Test: High prolactin levels can indicate pituitary problems, such as a prolactinoma (a benign tumour in the pituitary gland). This test is often administered when low testosterone is detected.
Blood Haemoglobin (Hgb): Haemoglobin transports oxygen throughout the body. Low Hgb levels in patients with low testosterone may signal blood disorders or related health concerns.
Thyroid Hormone Tests: Thyroid function is also evaluated, as thyroid disorders can affect testosterone levels, mood, and energy, contributing to symptoms often associated with low testosterone.
Remember, it's possible to have symptoms similar to male menopause without any changes in your body's physiology. Everything from mental health conditions to lifestyle factors can make you feel fatigued, less motivated, and even cause erectile dysfunction issues. However, we recommend you go for a health check to ensure there's nothing else going on.
Treatment Options
Testosterone Replacement Therapy
The primary way to treat low testosterone in men is testosterone replacement therapy (TRT). Similar to hormone replacement therapy (HRT) in women, it increases hormone levels to counteract your symptoms. It's not a cure.
TRT is available as (5):
Transdermal gel, cream, or patch
Short- or long-acting injection
Oral medication
Nasal inhaler
Implantable pellet (3 months or 6 months)
Lifestyle Changes
Testosterone is influenced by your lifestyle as well as your age. Factors such as weight, diet, exercise levels, sleep, stress, and more can affect your health and testosterone. Consider these lifestyle adjustments:
Achieve a healthy weight
Exercise for 150 minutes per week
Eat a healthy diet rich in lean meats, healthy fats, whole grains, fruits, and vegetables
Sleep 7-8 hours per night
Reduce or eliminate smoking or alcohol
Practise stress-reducing exercises, e.g., meditation, journaling, or yoga
Mental Health Support
Dealing with low mood, low energy, and a lack of enthusiasm for life is a struggle for many older men. Seeking mental health support is crucial to getting better. From your local doctor to specialist services for men, there are plenty of options available.
Men's Sheds Association – A community initiative that provides social connections and activities for older men to combat loneliness and isolation.
Heads Up Guys – An online resource for men battling depression, offering support, tools, and advice tailored to men's mental health needs.
Mind: Men and Mental Health – A comprehensive guide to mental health resources specifically for men, including advice and support services.
Better Health Every Mind Matters – The NHS resource for mental well-being, with tailored guidance for men to manage mental health challenges.
CALM (Campaign Against Living Miserably) – A charity focused on preventing male suicide, offering a helpline and online support for men experiencing mental health issues.
It's also men's health awareness month in November. You'll find a bunch of resources available throughout the month to support and help you deal with this issue.
Final Thoughts
Is male menopause a myth or a real condition? It's certainly not the same as female menopause, which is a sudden change in hormone levels. However, it would be wrong to say it's entirely a myth.
Men experience a gradual decline in testosterone levels as they age, which can lead to a range of symptoms, including low mood, reduced muscle mass, testicular changes, erectile dysfunction, and more. Men should take a testosterone test to confirm the underlying cause.
Prioritise your health and well-being with our tailored Well Man Check at Health Klinix. This comprehensive assessment covers vital areas, including heart health, hormone levels, and prostate screening, to help you maintain peak performance. Schedule your appointment today for proactive, professional health management.
References
Written by:
Dr Joseph Nightingale, MBBS, MSc
Reviewed and approved by:
Dr Ravi Gowda, Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
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