Understanding Andropause: Male Menopause Explained

Almost everyone is familiar with menopause, the biological process that marks the end of a woman's reproductive years. However, fewer people know about andropause, the male equivalent, which involves a gradual decline in testosterone levels. Though less discussed, andropause is a medical reality with its own set of symptoms and misconceptions.

What is Andropause?

In women, menopause marks the end of menstruation and a significant drop in estrogen levels, typically occurring around age 50. Men, on the other hand, experience a gradual decline in testosterone, starting in their mid-30s, with levels decreasing by about 1.6% per year. By age 75, a man may have lost about 30% of the testosterone he had at 25.

Dr. Robert H. Eckel, a professor emeritus at the University of Colorado, emphasizes that andropause is different from menopause. "It's a gradual fall," he explains, "nothing like menopause, which occurs over a finite period."

The Role of Testosterone

Testosterone is crucial for sexual function, bone health, fat metabolism, muscle mass, and strength. It peaks during adolescence and declines with age. However, the decline is typically not concerning unless it leads to symptoms such as decreased sex drive, erectile dysfunction, difficulty concentrating, decreased energy, or depression.

Dr. Nannan Thirumavalavan, chief of male reproductive and sexual health at the Urology Institute of University Hospitals in Cleveland, notes that low testosterone without symptoms is not usually a cause for concern. "Andropause is part of the aging process, but it isn't a disease on its own," he says.

Symptoms and Diagnosis

When testosterone levels fall significantly, men may experience symptoms like reduced libido, erectile dysfunction, difficulty concentrating, and decreased energy. These symptoms can also be caused by other health issues, such as obesity, sleep apnea, cardiovascular disease, Type 2 diabetes, or kidney disease.

To diagnose low testosterone, multiple blood tests are needed due to natural fluctuations throughout the day. Both biochemical measurements and a thorough history and physical examination are required.

Treatment Options

Testosterone therapy has been heavily marketed, but the Endocrine Society's guidelines recommend against routine testing of testosterone levels in men without symptoms. Long-term testosterone therapy's benefits and risks remain unclear.

For men over 65, therapy should be considered on an individual basis after discussing potential risks and benefits. While testosterone therapy can modestly improve sexual function, it won't restore youthful levels of vigor.

Men seeking help for symptoms should consult their primary care doctor, urologist, or endocrinologist. However, testosterone therapy can have side effects, including acne, increased blood pressure, and an enlarged prostate. It also shuts down the body's natural testosterone production, ceasing sperm production, which is problematic for those hoping to father children.

The FDA requires warnings about the potential increased risk of heart attacks and strokes with testosterone products. However, a 2023 study in the New England Journal of Medicine showed that testosterone replacement therapy did not increase major cardiac risks in middle-aged and older men, an important finding for its safety.

Lifestyle Changes and Supplements

Over-the-counter supplements claiming to boost testosterone lack evidence for their effectiveness. Men can naturally improve their testosterone levels by getting quality sleep, losing excess weight, eating a healthy diet, and exercising.

Understanding andropause is essential for addressing the symptoms and improving the quality of life for aging men. While it doesn't have the same cultural recognition as menopause, acknowledging andropause's impact is a critical step toward better health and well-being for men.