Andropause (Male Menopause)

Male menopause” is the more common term for andropause. It describes age-related changes in male hormone levels. The same group of symptoms is also known as testosterone deficiency, androgen deficiency, and late-onset hypogonadism.

Male menopause involves a drop in testosterone production in men who are age 50 or older. It’s often affiliated with hypogonadism. Both conditions involve lowered testosterone levels and similar symptoms.

If you’re a man, testosterone is a hormone produced in your testes. It does more than fuel your sex drive. It also fuels changes during puberty, fuels your mental and physical energy, maintains your muscle mass, regulates your fight-or-flight response, and regulates other key evolutionary features.

Male menopause differs from female menopause in several ways. For one thing, not all men experience it. For another, it doesn’t involve a complete shutdown of your reproductive organs. However, sexual complications may arise as a result of your lowered hormone levels.

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The decrease in testosterone is an important factor in men suspected of having andropause. However, as men age, not only does the body start making less testosterone, but also the levels of another hormone called sex hormone binding globulin (SHBG), which pulls usable testosterone from the blood, begins to increase. SHBG binds some of the available testosterone circulating in the blood. The testosterone that is not bound to the SHBG hormone is called bioavailable testosterone, meaning it is available for use by the body.

Men who experience symptoms associated with andropause have lowered amounts of bioavailable testosterone in their blood. Therefore, tissues in the body that are stimulated by testosterone receive a lower amount of it, which may cause various physical and possibly mental changes in a person such as mood swings or fatigue.

However, the relationship of these symptoms to decreased testosterone levels is still controversial. Unlike menopause in women, when hormone production stops completely, testosterone decline in men is a slower process. The testes, unlike the ovaries, do not run out of the substance it needs to make testosterone. A healthy man may be able to make sperm well into his 80s or later.

There are many risk factors for Andropause, such as:

  • Diabetes;
  • Premature andropause can occur in men who experience excessive female hormone stimulation through exposure to toxic estrogen look-alikes. Estrogen dominance is more common in men and women who drink recycled water, live near incinerators, work in the pharmaceutical industry, or live near plastics, dyes or other chemical factories, or on farms that use pesticides and other chemicals.
  • Overweight;
  • Hypertension (high blood pressure);
  • Alcohol, especially regular or excessive use.
  • Pharmaceutical drugs such as: antidepressants; antibiotics such as erythromycin; antifungals such as ketoconazole; beta blockers for high blood pressure; thiazide diuretics (water pills); immune suppressants; antipsychotics; cancer chemotherapy; and some infertility treatment hormones that have estrogen-like effects.
  • Tobacco;
  • Marijuana;
  • Genetic disorders that produce hypogonadism, including Klinefelter’s, Wilson-Turner’s and Androgen insensitivity syndromes.

Male menopause can cause physical, sexual, and psychological problems. They typically worsen as you get older. They can include:

  • low energy
  • depression or sadness
  • decreased motivation
  • lowered self-confidence
  • difficulty concentrating
  • insomnia or difficulty sleeping
  • increased body fat
  • reduced muscle mass and feelings of physical weakness
  • gynecomastia, or development of breasts
  • decreased bone density
  • erectile dysfunction
  • reduced libido
  • infertility

You may also experience swollen or tender breasts, decreased testicle size, loss of body hair, or hot flashes. Low levels of testosterone associated with male menopause have also been linked to osteoporosis. This is a condition where your bones become weak and brittle. These are rare symptoms. They typically affect men at the same age as women entering menopause.

To make the diagnosis of male menopause, the doctor will:

  • Perform a physical exam;
  • Ask about symptoms;
  • Order blood tests, which may include measuring testosterone level.

The reason is that there are other conditions that are associated with low testosterone levels (e.g., hypogonadism, which causes retardation of sexual growth and development; diabetes; high blood pressure), your doctor will likely do tests to rule out these possibilities before making a diagnosis of andropause. It is important to note that many of the symptoms associated with andropause are also a normal part of aging, and they may not be reversible with treatment.

Replacing testosterone in the blood: It is the most common treatment for men going through andropause. This treatment may provide relief from the symptoms and help improve the quality of life in many cases. Just as with hormone replacement therapy in women, testosterone replacement therapy has potential risks and side effects. Replacing testosterone may worsen prostate cancer, for example. If you are considering androgen replacement therapy, talk to a doctor to learn more and weigh all of the positives and negatives before making your decision.

Testosterone is available in a variety of different preparations including skin patches, capsules, gels, and injections. Your doctor will help determine which treatment is best for you and will often consider your lifestyle when making this decision. Follow-up visits with your doctor will be important after the initial treatment begins. At follow-up visits, your doctor will check your response to the treatment and make adjustments in necessary cases.

  • Skin patches: People who wear a patch containing testosterone receive the hormone through the skin. The patch allows a slow, steady release of testosterone into the blood stream. It is applied once a day to a dry area of skin on the back, abdomen, upper arms, or thighs.
  • Testosterone gel: This treatment is also applied directly to the skin, usually on the arms. Because the gel may transfer to other individuals through skin contact, a person must take care to wash the gel from the hands after each application.
  • Capsules: Taken twice daily after meals, this is yet another option for testosterone replacement. Men with liver disease, poor liver function, serious heart or kidney disease, or too much calcium in their blood should avoid testosterone capsules.
  • Testosterone injections: This treatment involves injections of testosterone (testosterone cypionate* and testosterone enanthate) in the muscle every 2 to 4 weeks. They may cause mood swings due to changes in testosterone levels. Men with severe heart disease, severe kidney disease, or too much calcium in their blood should avoid testosterone cypionate. Men with severe kidney disease should not take testosterone enanthate.

Testosterone should not be taken by any man with prostate or breast cancer. If you have heart disease, or taking some medications such as blood thinners, or have an enlarged prostate, and have kidney or liver disease, you will need to discuss with your doctor whether or not testosterone therapy is right for you.

The most common type of treatment for symptoms of male menopause is making healthier lifestyle choices. For example, your doctor might advise you to:

  • eat a healthy diet
  • get regular exercise
  • get enough sleep
  • reduce your stress

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