Male menopause

What is male menopause?

It is well known that menopause in women signals a massive drop in female hormones like estradiol (estrogen) and progesterone in the body. Similarly, male menopause is a condition in which men aged 50 or above experience a natural decline in the level of testosterone in the body.

Male menopause is also known as andropause and late-onset hypogonadism, and it is absolutely normal. Research shows that testosterone levels in men start declining around 30 years of age and continue to decline throughout life.

What is the normal level of testosterone in adult males?

The jury is still out on this. Research is on, but reproductive health scientists say that it’s difficult to arrive at this range because the level of testosterone in the body fluctuates through the day and varies between individuals. That said, the testosterone test defines normal range as:

• 249-836 nanograms (ng) of testosterone per 10 litres (decilitre or dL) of blood in men aged 19-49
• 193-740 ng/dL in men aged 50 and above.

What does testosterone do, really?

Testosterone is, of course, the male sex steroid hormone (androgens). Apart from regulating sex drive, it is responsible for:

• The development of the penis and testes
• Puberty, including an increase in muscle mass, facial hair and change in voice at this time
• Bone growth
• Semen production
• Brain function, including regulating the mood
• Maintaining an adequate number of red blood cells in the body

What are the symptoms of male menopause?

Because testosterone performs so many functions in the body, the decline in testosterone has various health effects such as:

• Low libido or sex drive
• Lower energy levels and weakness
• Higher body fat and less muscle mass, with possible weight gain
• Gynaecomastia: or the development of male breasts
• Difficulty achieving and maintaining an erection and erectile dysfunction

In addition to these, there may also be psychological effects like mood swings, sadness, depression and difficulty sleeping because of the hormonal imbalance in men. Some men may also experience loss of self-confidence and stress linked to sexual dysfunction. It is a good idea to seek professional help if you feel overwhelmed by the changes in your body and in your sex life.

What are the causes and risk factors of male menopause?

Also known as late-onset hypogonadism, male menopause occurs because of a natural drop in testosterone levels after about 30 years of age. Research shows that testosterone levels continue to decline—to varying degrees—in most men till the age of 80.

There are some factors that exacerbate the condition, though. These include:

• Obesity
• Chronic illnesses: Of course, older age is also a risk factor for diseases like hypertension and diabetes
• Some medicines also affect the production of testosterone in the body

How is male menopause diagnosed and treated?

For most men, age-related decline in testosterone is slow and the symptoms are manageable without treatment. Eating healthily and exercising regularly are known to help, too.

In terms of diagnosis, the testosterone test is the surest way to diagnose low testosterone. If you are over 50 and your blood test results show low levels of testosterone, your doctor will ask you a few questions about your medical history and do a physical examination to rule out any other causes before confirming male menopause.

Usually, this condition does not require treatment. However, testosterone replacement therapy may be prescribed in some cases. Research is divided on the potential side effects of this therapy, including on heart health. The therapy is also contraindicated in some cases, like in people living with prostate cancer.

Read more: Natural ways to boost testosterone

What are the complications of male menopause?

In addition to lower sex drive and muscle mass, male menopause also affects bone density and haemoglobin levels in men. Research shows that it may also be linked to a higher risk for anaemia, osteoporosis and all-cause mortality in men.

How is male menopause different from testosterone deficiency and male hypogonadism?

Testosterone deficiency is a state in which the body does not produce enough testosterone. This can occur for a number of reasons. Chief among them are:

• Older age
• Injury to the testes
• An infection
• Certain diseases like liver cirrhosis, kidney failure, hemochromatosis (too much iron in the blood), HIV/AIDS, obesity, type 2 diabetes and obstructive sleep apnea (a condition in which the airways close up while sleeping, denying oxygen to the body and brain)
• Brain injury
• Klinefelter syndrome (in which men are born with an extra X chromosome)
• Alcoholism
• Chemotherapy
• Certain medicine, including steroids and opioids

Male menopause refers to age-related decline in testosterone levels only. According to research, testosterone levels rise from puberty until about 30 years of age and then start declining. Research shows that age-related decline in testosterone levels can vary depending on:

• Overall health: Testosterone decline is greater in people with comorbidities
• Weight: It is also greater in overweight and obese men of advancing age
• Race: Research also shows that the amount of decline varies by race—caucasian Americans have higher peak testosterone levels, according to one study, so the decline with age is also sharper among this population.

Male hypogonadism is another condition in which the body produces less testosterone at any stage of life—if hypogonadism occurs before birth, it can lead to the development of female, ambiguous or underdeveloped male genitals in a baby boy.

So in all three conditions, there’s a lower level of testosterone in the body but the causes and manifestations are slightly different.

Is male menopause just like female menopause?

There are some similarities:

• Like female menopause, male menopause is linked to advancing age and declining levels of sex hormones.
• Like female menopause, male menopause can cause mood swings, irritability, hot flashes and lower libido.
• Like female menopause, one of the treatments for male menopause is hormone replacement—research shows testosterone hormone replacement in older men may improve sex drive, bone density and even reduce anaemia in men with very low testosterone levels.

However, there is one major difference between male and female menopause: whereas female menopause marks the end of the reproductive years in a woman’s life, male menopause does not. Of course, it affects libido, the ability to get and sustain an erection and fertility, but men can still father children after hitting male menopause.