The effects of hormonal changes related to aging in men are different from women. In their late 50s or early 60s, some men might start wondering, “Why is my belly now sagging? Why do the chest muscles that used to be tight now seem to be sagging?
Why does sex now seem less appealing? When did all of this start?” Undeniably, these questions will lead men to think, “Am I experiencing male ‘menopause’?”
What is Andropause?
Menopause is a term for women, which literally means “end of the monthly cycle or menstruation.” The word originates from the Greek “pausis,” meaning stop, and “mēn,” meaning month. In men, a similar condition to menopause is called andropause.
This term comes from the Greek “andras,” meaning man, and “pausis,” meaning stop. So, literally, andropause is a condition where a man “stops” being a man. This condition is associated with a decrease in sexual satisfaction or a general decline in body fitness, accompanied by low levels of male sex hormones, specifically testosterone.
Differences Between Andropause and Menopause
Like women, men will experience a decrease in sex hormone levels as they age. However, in men, this decline happens gradually, and the signs of andropause are more subdued and progress slowly. The decrease in levels of the main male sex hormone, testosterone, starts around the age of 30. Instead of drastically decreasing over a few years, testosterone levels decline slowly, about 1 percent per year throughout a man’s life. This change is so “slight” that its effects are not strongly felt by most men. That’s why various terms have emerged referring to the andropause process, such as androclise, androgen decline in aging male (ADAM), testosterone deficiency syndrome, aging male syndrome, and late-onset hypogonadism (LOH).
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This decrease in testosterone levels impacts sexual capacity, strength, and other abilities in men. However, unlike women, men don’t lose their fertility with andropause; it simply decreases. Men can still remain fertile and have offspring naturally into their 50s and 60s.
True andropause only occurs in men who have lost testicular function due to conditions like disease or physical injury or in men with advanced-stage prostate cancer who need medical castration. So, does this decrease in testosterone levels cause noticeable symptoms in men?
Symptoms and Diagnosis of Andropause
Certainly, there are symptoms of andropause, but they are usually not pronounced, leading men to tend to overlook them. These symptoms can also resemble those of stress or other causes.
Currently, the diagnosis of andropause is based on symptoms and signs that point towards testosterone deficiency. The symptoms most associated with andropause are low sexual desire (libido). Other potential symptoms include:
Reduced spontaneous morning erections leading to erectile dysfunction.
Decreased strength and muscle mass.
Development of fat deposits in the abdomen and chest (gynecomastia).
Reduced bone density and osteoporosis.
Emotional and psychological changes, tendencies towards depressive moods.
Reduced energy levels. Sleep disturbances or quick fatigue.
Decreased concentration/focus and forgetfulness.
These symptoms are not specific to low androgen levels, but they raise suspicion of testosterone deficiency. Therefore, the appearance of these symptoms must be confirmed by measuring low serum testosterone levels. Results from the European Male Aging Study (EMAS) indicate that the presence of three sexual symptoms (reduced libido, morning erections, and erectile dysfunction) along with a total testosterone level less than 11 nmol/L and free testosterone less than 220 pmol/L can be considered as minimum criteria for diagnosing andropause in elderly men. Experts suggest that testosterone level examinations in older men should be conducted only if symptoms are present. If the initial test results show low testosterone levels, the test should be repeated to confirm the findings. If confirmed low testosterone levels are found, further tests are carried out to evaluate pituitary gland hormones to determine the cause and rule out other hormone disorders. The pituitary gland is located at the base of the brain and plays a crucial role in the hormonal system, as it regulates the production and release of various hormones in the body.
It’s important to note that the intensity of symptoms related to low testosterone levels varies widely, and not all men will experience the same symptoms. Additionally, signs and symptoms associated with low testosterone are not specific and can also be caused by medication use or specific conditions, such as:
Obesity
Depression
Hypothyroidism
Alcoholism
Use of medications like corticosteroids, cimetidine, spironolactone, digoxin, opioid analgesics, antidepressants, and antifungal drugs.
These factors should be ruled out before making an andropause diagnosis. Similarly, acute illnesses that might temporarily lower testosterone levels should also be considered.
Is Treatment Necessary?
Recommendations for testosterone hormone therapy in older men with low testosterone levels vary. In 2020, the American College of Physicians recommended that doctors consider initiating testosterone hormone therapy in men with sexual dysfunction who wish to improve their sexual function, after explaining the risks and benefits. In 2018, the Endocrine Society suggested that this therapy could be given to older men with low testosterone levels and related symptoms. However, some experts allow hormone therapy for men who do not exhibit specific symptoms.
For some men, hormone therapy can alleviate disruptive symptoms due to testosterone deficiency. However, for others, the benefits are unclear, and there are risks associated with the therapy. While further studies are still needed, testosterone hormone therapy can potentially stimulate the growth of metastatic prostate and breast cancer.
This therapy can also increase the risk of heart attacks, strokes, and contribute to the formation of blood clots in the veins. Based on this, doctors won’t recommend testosterone therapy if men have a history of prostate or breast cancer, severe untreated sleep apnea, uncontrolled heart failure, or thrombophilia (excessive blood clotting), or if they have recently experienced a heart attack or stroke.
Are There Natural Ways to Slow Andropause?
Outside of hormone therapy, there are other ways to stimulate testosterone production in men, thus potentially slowing down andropause.
Some tips include:
Maintaining a balanced and nutritious diet rich in protein, minerals, and fiber. Avoid overeating.
Engaging in high-intensity physical exercises according to one’s capacity to reduce stress and increase muscle mass.
Ensuring sufficient rest, which means getting at least 7-9 hours of sleep per day.
Maintaining sexual activity to avoid erectile dysfunction. Reducing or avoiding caffeine, tobacco (smoking), and alcohol consumption.
Communicating feelings about experienced changes with a partner or close friend.
Studies have found that men who manage to maintain high testosterone levels beyond the age of 50 have better physical fitness and endurance, improved mood, and better responsiveness.
Conclusion If you feel you’re experiencing andropause, don’t hesitate to consult a doctor about the symptoms you’re experiencing, the necessary examinations, and potential treatment options. Doctors will help provide considerations regarding the pros and cons of treatment according to your condition.
Source:
Singh P. Andropause: Current concepts. Indian J Endocrinol Metab. 2013 Dec;17(Suppl 3):S621-9. doi: 10.4103/2230-8210.123552. PMID: 24910824; PMCID: PMC4046605.
Tajar A, Huhtaniemi IT, O’Neill TW, Finn JD, Pye SR, Lee DM, et al. EMAS Group. Characteristics of androgen deficiency in late onset hypogonadism: Results from European Male Aging Study (EMAS) J Clin Endocrinol Metab. 2012;97:1508–16.
Mayo Clinic. [Last reviewed May 24, 2022]. Male menopause: Myth or reality? URL: https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056
After graduating from the Faculty of Medicine, University of Indonesia, dr. Fiona served as a Non-Permanent Employee (PTT) doctor from the Indonesian Ministry of Health in a remote village in Luwuk-Banggai Regency, Central Sulawesi. This experience led her to continue her master's degree in International Health at Gadjah Mada University, Yogyakarta.
