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Male Menopause: Is it Real?

June 30, 2023

Backpacking man

Menopause is a normal milestone women reach when they hit a certain age, but what about men? Is there a male version of menopause? The short answer is, sort of.

The medical community refers to the age-related hormonal
changes in men (meaning, a drop in testosterone production) as andropause — but it’s not the same as what women experience during menopause. In fact, it’s quite different.

Sonoo Advani, MD, a fellowship-trained endocrinologist with Atlantic Health System, explains the differences between menopause and so-called manopause; what really happens hormonally to men as they age; the symptoms, causes and risk factors of low testosterone; and why diagnosis and treatment isn’t as simple as a blood test.

Menopause vs. manopause

All menstruating women will eventually go through menopause,
which typically begins 12 months after their last period. The time leading up to menopause is referred to as perimenopause, and the time after menopause is known as postmenopause. While everyone is different, women reach menopause, on average, around age 50.

When a woman enters perimenopause, her sex hormone production (specifically, estrogen and progesterone) begins to slow; in menopause, it drops quickly and dramatically. Symptoms can vary, but hot flashes, mood swings and irregular periods are the most common and can be severe.

For men, the decline in sex hormone production (in this case, testosterone) is gradual — about 1% each year after age 40 — although Dr. Advani notes that the beginning age of decline may vary based on a man’s lifestyle and personal health.

Most older men still have testosterone levels that are considered “in range” later in life. For example, according to Dr. Advani, it’s normal for a 60-year-old man to have a testosterone level of 400.

Symptoms of low testosterone

While a slow, gradual drop in testosterone is natural, a small percentage of older men experience considerably lower levels of testosterone.

If your blood testosterone reading is less than 300 nanograms per deciliter (ng/dL), you have andropause or androgen decline in the aging male (ADAM). In other words, low testosterone or low T.

Dr. Advani warns that signs of low T are subtle and often go unnoticed. Symptoms are often brushed off as part of aging or are associated with other medical conditions, like heart disease, diabetes, obesity or high blood pressure.

That said, the most common symptoms suggestive of low T include:

  • Low sex drive (including both desire and activity)
  • Decreased spontaneous erections or erectile dysfunction
  • Low energy and reduced strength
  • Weight gain, especially around the middle, and muscle loss

Other common symptoms may include:

  • Irritability, moodiness and/or depression
  • Poor sleep quality and increased sleepiness
  • Low bone mineral density or height loss (shrinking)

Is it low T or something else?

The tricky part is figuring out why you have these symptoms. Is it low T, or something else?

Some lifestyle factors can produce many of the same symptoms as low T. Specifically:

  • Alcohol consumption
  • Lack of exercise
  • Poor diet
  • Poor sleep
  • Stress

Additionally, some health conditions can cause secondary low T, such as being overweight or taking certain medications such as some antidepressants.

Figuring out if your symptoms are a sign of natural, age-related low T (primary andropause) or if they are the result of an underlying health condition (secondary low T) is key.

“If you are overweight, you need to focus on that first,” Dr. Advani says. “A high fat mass raises insulin resistance and suppresses the pituitary gland, which produces testosterone. Once you lose weight, your testosterone levels will naturally improve.”

Diagnosis and Treatment

If you are experiencing low libido, which is the most common
symptom, you can ask your primary care doctor to order fasting testosterone level blood work.

“Because testosterone levels have a circadian rhythm, they peak at 8 a.m.,” Dr. Advani says. “If your levels are low, your doctor will refer you to an endocrinologist to check your pituitary gland, where testosterone is produced. You should also see a urologist to check your prostate and testes for tumors or functional disorders. Diagnosis is really a collaborative effort.”

Testosterone Replacement Therapy (TRT)

If your testosterone is under 300 and you have symptoms, one
option is testosterone replacement therapy (TRT).

While it’s not appropriate if you have sleep apnea or some other medical conditions, TRT is a safe option for most men — as long as you have a normal prostate exam and bone density test before starting treatment and are monitored regularly.

“Testosterone therapy is proven to be safe, as long as you are monitored by a doctor,” Dr. Advani says. “It does not cause heart disease, as a new study published in the New England Journal of Medicine confirms, and it does not cause prostate cancer. Some people may develop mild benign prostate hypoplasia (BPH), or an enlarged prostate, but TRT doesn’t cause tumors to grow.”

As safe as TRT is, Dr. Advani does caution men who aren’t experiencing symptoms. “We don’t want to treat men with age-appropriate low T if they don’t have symptoms because adding testosterone will suppress the pituitary and their natural androgen testosterone production,” she says. “It should not be used just to lose weight or increase your muscle mass.”

Aging is inevitable, but it doesn’t have to be miserable. As Dr. Advani says, “It is important to recognize andropause and treat it because it can affect your quality of life and lead to bigger health problems and comorbidities, like diabetes.”