According to men’s health experts, it is incorrect to label decreasing testosterone levels or reduction in the bioavailability of testosterone due to aging “male menopause.” In female menopause, ovulation ends and hormone production suddenly drops during a short period of time. Due to the decline in estrogen and progesterone levels, women experiencing menopause are no longer menstruating and cannot bear children. On the other hand, male androgen levels slowly decline over time.
Middle aged and elderly men are more likely to experience andropause in lowered testosterone levels. Andropause, testosterone deficiency, or late-onset hypogonadism are preferred alternatives to describe male aging hormone changes over an extended period of time. The British Association of Urological Surgeons (BAUS) refers to male menopause as Androgen Deficiency in the Ageing Male (ADAM), due to the decrease in androgen (testosterone) levels.
Many symptoms are shared with female menopause and, for this reason, the name “male menopause,” or “man-opause” colloquially, has become widely cemented in public usage, along with the accompanying misconceptions and misinformed connotations. While aging men may be affected by hormone changes, and in fact Northwestern Memorial Hospital researchers even estimated about five million men in the USA are affected, it is debatable if there is a well-defined period of menopause for men as there is for women.
Symptoms of Male Menopause
It is debatable whether the physical and emotional changes seen in aging men are directly correlated to declining hormone levels. In a 2010 study published by The New England Journal of Medicine, 3,219 men between the ages of 40 and 79 were surveyed about their average sexual, physical, and psychological health, and their testosterone blood level was measured.
Researchers found that only three symptoms define late-onset hypogonadism: “less frequent morning erections, diminished libido, and erectile dysfunction.” The average testosterone level was 17 nmol per liter, with less than 11 nmol per liter as a cutoff factor in determining late-onset hypogonadism. Other less prevalent symptoms included decreased strenuous physical activity and less energy, fatigue, and sadness.
However, testosterone levels between men who had symptoms and men who did not have symptoms did not greatly vary, indicating a lack of correlation between symptoms and testosterone levels.
Symptoms of andropause include changes in sexual function, sleep patterns, and physical and emotional changes. Aging males with lower testosterone levels may suffer from anxiety, sadness, hot flashes, and increased sweating, decreased libido, erectile dysfunction, weight imbalances, skin problems, fatigue, and poor concentration and memory (Heller and Myers).
Normally, a decrease in testosterone at about 1% per year begins at 30. However, not every man is symptomatic of late-onset hypogonadism, and of those who are, there are several different contributing factors. Causes of late-onset hypogonadism include individuals who have cardiovascular problems, along with underlying health problems and other physical and emotional stressors.
Effects of Hypotestosteronemia
Hypotestosteronemia, as defined, is the abnormally low concentration of testosterone due to primary or secondary hypogonadism. It may be congenital or acquired. In regular male aging, testosterone levels decline by as much as 50% between 25 to 75 years of age, and as many as 50% of men older than 50 years have hypotestosteronemia.
A possible “treatment” is testosterone replacement therapy, but this method of restoring testosterone is controversial for its associated health risks, including prostate cancer. Alternative treatments for late-onset hypogonadism depend on the cause and include changes in lifestyle such as dieting and/or exercising, or medications such as antidepressants.
According to the NEJM study, only 2% of participants fell under the description for late-onset hypogonadism, with the elderly age bracket more likely to be diagnosed than the middle-aged men. Thus, men who are receiving testosterone replacement therapy may be doing so for symptoms of andropause that occur even in men without late-onset hypogonadism.
- Western Journal of Medicine, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070997/.
- Examining “male menopause”: myth or malady? http://healthland.time.com/2010/06/16/examining-the-myth-of-male-menopause/.
- Secondary hypogonadism in older men: its relation to impotence. Korenman SG, Morley JE, Mooradian AD, Davis SS, Kaiser FE, Silver AJ, Viosca SP, Garza D, J Clin Endocrinol Metab. 1990 Oct; 71(4):963-9.
- Tenover JL. Testosterone and the aging male. JAndrol 1997;18:103-106.