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Men's health & wellbeing

Understanding the male menopause and mental health

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You’ve probably heard of the menopause in women, but did you know men go through a similar hormonal change as they age? The male menopause, or andropause, is often triggered when men reach their 40s.

In fact, as many as 30% of men can expect some sort of physical change to their bodies when they reach this age. But with such little exposure to information, this sudden shift in mental attitude and physical ability can come as a real shock.

In this guide, we’ll discuss all aspects of the male menopause. From spotting the early signs, to finding out what you can do to alleviate the symptoms, find out what you can do to tackle the challenges of the andropause.

01

Understanding the male menopause
  • The impact of testosterone on a man
  • Male menopause – fact or fiction?
  • Differences between male and female menopauses

02

Changes to your body caused by male menopause
  • What are the symptoms?
  • Diagnosing male menopause in someone
  • Changes which occur in your body

03

Impact of the male menopause on mental health
  • The direct effect of male menopause on mental health
  • The indirect effect of male menopause on your mental health

04

Treating male menopause
  • Testosterone replacement therapy
  • Finding a healthy diet
  • Getting the right level of exercise

05

Secondary Reading
  • Secondary sources
  • Useful links
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CHAPTER 01

Understanding the male menopause

What is the male menopause?

The male menopause is the name given to an age-related change in the hormone levels of men. There are several factors which could cause a person to enter this stage of their life.

Some of the most common include:

  • Testosterone deficiency
  • Increasing SHBG levels
  • Reduced pituitary function
  • Reduced production of testosterone by the testicles
  • Increasing insulin resistance/onset of diabetes

In all of these cases, it’s the dramatic reduction in the amount of testosterone the body produces which causes the menopause to kick in. While these factors won’t affect everyone as they age, it can have a huge impact on individuals who do see a dip in production.

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In all of these cases, it’s the dramatic reduction in the amount of testosterone the body produces.

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The impact of testosterone on a man

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Testosterone is a hormone which has been closely associated with the concept of being “manly” for decades. And while things are a little less black and white than that, it’s certainly true that the amount a man produces will have a direct impact on his behaviour and physical and mental health.

There are a host of areas which are controlled by the amount of testosterone in your body. Those include:

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Heart

Testosterone increases your cardiac output, while also helping to keep the coronary and peripheral blood flow smooth and continuous.

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Brain

Cognition, memory and feeling are all affected by testosterone in the brain, as well as a man’s sex drive.

kidneys

Kidneys

Red blood cell production decreases when there’s less testosterone in your system. This happens because erythropoietin production is halted or reduced.

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Muscles

The mass and strength of your muscles are directly impacted by the amount of testosterone in your body.

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Sexual Organs

Sperm production and prostate health are both directly affected by a lack of testosterone. Erectile dysfunction is also not uncommon.

With so many parts of the male anatomy affected by Testosterone, it’s not hard to see why some people see the male menopause as a genuine threat for their later years.

Male menopause – fact or fiction?

“Male menopause” is commonly used as a title because it affects men as they age, and has similar symptoms to the female menopause. But is it the same?

In truth, not quite. The term is something of a misleading tagline. While there is a very real change which happens to some men at a certain point in their life, the name itself encompasses a lot of different conditions.

The one key link between them all? A large dip in that all-important testosterone. While some people see the term as a simple way of describing the loss of this hormone, others would suggest that inaccurately grouping these conditions under one umbrella is a risky practice.

The minor controversy over the name stems from the fact that this, unlike female menopause, is not something which all men will naturally experience in their lives.

It’s very common for a man’s testosterone levels to decrease by as much as 1% every year after the age of 40. This is not the same as late-onset hypogonadism or androgen deficiency, which can see a much larger sudden dip in levels.

It’s for this reason some medical professionals like to steer clear of the term “male menopause” altogether. It’s natural for testosterone levels to lower, but extreme cases are a condition in and of themselves.

So, is the male menopause real? Well, yes and no. While you won’t definitely experience this drastic shift in hormone levels, there’s roughly a one-in-three chance you could. Just don’t take the slightest change in levels when you’re 50 to mean you’re going through “the change”.

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It’s very common for a man’s testosterone levels to decrease by as much as 1% every year after the age of 40.

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Differences between male and female menopauses

There are a lot of similarities between male and female menopauses. In fact, as we’ve discussed, these shared attributes are responsible for the origin of the name.

Ultimately though, there are a number of key differences between men and women:

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Rate of change

Women often find changes to their body happen overnight. And while the overall process of menopause will last for years, the beginning of the process is very easy to spot. With men, it’s usually more of a gradual thing, as testosterone production begins to gradually slow down.

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Reproductive capabilities

When a woman goes through menopause, she’ll no longer be able to have children. While sexual libido is likely to drop in men, it won’t always mean they won’t still be able to father a child.

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The guaranteed nature

As we’ve already alluded to, not all men will go through male menopause. While everyone will naturally see testosterone levels decrease over time, only 30% experience the rapid drop-off associated with the condition. Meanwhile, all women experience a menopause.

While the two are comparable, it would be wrong to suggest they’re totally alike. As we’re about to discover, the changes that occur in men are sometimes quite different.

While the two are comparable, it would be wrong to suggest they’re totally alike. As we’re about to discover, the changes that occur in men are sometimes quite different.

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CHAPTER 02

Changes to your body caused by male menopause

Changes which occur in your body

While not as drastic as what a woman will experience, there is a noticeable change to a man’s body when he goes through male menopause. Some of the most common changes you can expect to experience are things like:

Increased body fat

The male menopause can cause a man to put on a few extra pounds, despite not eating more than they normally would.

Breast tissue growth

Men may experience some form of gynaecomastia (the enlargement of male breasts).

Erectile dysfunction

While the relationship between erectile dysfunction and testosterone is still not fully understood, most medical professionals agree it is one of many reasons why someone might struggle to maintain an erection.

Lowered bone density

This is admittedly not something you’ll be able to pick up on in day-to-day life. It’s only after a short while that you’ll notice any issues. These will include aches and pains after minimal amounts of exercise or daily routines. You might also find that breaks happen more easily.

Loss of muscle mass

Someone going through the male menopause might notice their body is becoming less muscular, or that they’re finding it hard to put more muscle on. If a person is sticking to their usual workout routine (or general lifestyle), but find themselves losing muscle mass, it might be worth consulting a doctor about the cause.

You’ve probably already spotted that a lot of these changes will naturally occur in men as they age. That’s why you might want to look for other symptoms to know if you’re experiencing the full menopause.

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While not as drastic as what a woman will experience, there is a noticeable change to a man’s body.

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What are the symptoms?

Some of the changes your body experiences will be good signs something is up. But they’re not the only way to detect if something isn’t quite right with your testosterone levels.

Here are some other telltale signs which might indicate something has changed in your hormone levels:

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Low energy

If you’ve felt more lethargic in recent weeks it could be due to a dip in testosterone levels. You might find that even trivial tasks, like washing or cleaning the house, suddenly seem like too much effort to carry out.

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Difficulty concentrating

A lack of focus can also be a sign that something might be up. If following the thread of a conversation begins to feel like a struggle, testosterone levels in your body might have dropped below where they should be.

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Lowered libido

A lack of sex drive is often synonymous with male menopause. If you no longer feel the desire to be intimate with your partner, it could be a sign that there’s less testosterone in your system.

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Insomnia

Sleep patterns are also controlled by the amount of this all-important hormone. As a result, insomnia is common amongst men going through this phase of their life.

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Mood swings

Noticed yourself becoming more easily irritated or sad of late? Extreme fluctuations in hormone levels can have a huge impact on our general mood and attitude. It’s for this reason that people on steroids are often stereotyped as being angry and volatile.

If you spot anything that doesn’t quite seem right with your body, it might be time to turn to a medical professional.

It’s important to remember that experiencing one of the symptoms does not necessarily mean you’re going through the male menopause. Seek help when all, or most, start to feel like a regular occurrence.

Diagnosing male menopause in someone

Owing to the fact male menopause shares a lot of symptoms with the natural signs of ageing, most doctors are not quick to diagnose the condition.

As such, you’ll probably have to carry out blood tests to make sure the drop off in hormone levels is above the average for a man in his later years.

A doctor will want to rule out all other possibilities before diagnosing a patient as experiencing andropause.

Blood tests which a doctor might give you include:

Testosterone level

These will be conducted before noon, as everyone’s testosterone levels are naturally lower in the evening. There’ll often be two separate tests conducted to find out if there has been a sudden dip in levels. The second test will also prove the first is not an anomaly.

Luteinizing hormone

This lesser known hormone can have a huge impact on the T-levels in your body. High amounts indicate you’re having problems producing testosterone from your testicles, low amounts indicate you’re having problems with your pituitary gland.

Blood prolactin

Again, high levels of this might indicate a problem with the pituitary gland. It might also be a sign of tumours growing.

Follicle stimulating hormone

This test also assesses your pituitary gland function, and is important for sperm production and fertility. There might also be a semen sample taken.

Blood haematocrit and haemoglobin

As we’ve seen, some doctors are hesitant to diagnose andropause or male menopause. They’ll first want to ensure you are safe to start treatment and to check for other conditions. This can include tests which check for conditions such as sleep apnoea or circulatory issues.

Testosterone can increase red blood cell production so it is also important to ensure that levels aren’t too raised before starting therapy.

Other scans or tests which might be carried out are things like:

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A doctor will want to rule out certain conditions before diagnosing a patient as experiencing andropause.

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Oestradiol or oestrogen hormone

Oestradiol levels may be low in men with low testosterone levels as it is converted in the male body from testosterone. In the rare circumstances where a man might begin to develop breasts (known as gynaecomastia in men), Oestradiol hormones should be tested.

Bone density test

A specialist x-ray, called a DEXA scan, will be used to measure the levels of calcium in your bones. This is a relatively quick and completely pain-free process.

MRI

Likewise, an MRI scan might be done to assess the condition of your pituitary gland. This will probably only be done if there’s genuine concern on the part of your doctor.

Ultimately, your doctor will want to ensure you’re being given the best treatment possible for your body. That’s why they’ll go out of their way to ensure there are no other (potentially more harmful) underlying health factors which are causing the drop in testosterone.

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CHAPTER 03

Impact of the male menopause on mental health

Perhaps unsurprisingly, the sudden loss of such a core hormone can have a huge impact on someone’s mental health. Let’s take a closer look at how someone might struggle if they find themselves experiencing the male menopause.

The direct effect of male menopause on mental health

Owing to the importance of testosterone’s role in your brain, there’ll be very direct and noticeable changes to your general attitude. While this won’t always be negative, there are circumstances and symptoms which can lower your mood:

Memory loss

As you age, your cognitive function begins to decrease. This is what triggers memory loss in most older people. Some studies have recently linked this dip in memory retention to lowered levels of testosterone.

Concentration levels

It’s not that you’ll necessarily find yourself distracted more often, but rather just struggle to follow the flow of a normal conversation. Being distracted is natural, but if you’re finding it a struggle to keep up in one-on-one chats, you may want to get assessed.

Sex drive

The libido is one of the key areas of the mind which is affected by a loss of T-levels. While it won’t necessarily be as a result of problems maintaining an erection, this can also be a factor.

You might begin to feel like a different person if you’re experiencing the male menopause. Remember, if you’re ever having dark thoughts it’s important to talk about it with someone you trust.

The indirect effect of male menopause on your mental health

Sometimes the fallout from other issues someone experiences during the male menopause will cause them to have further problems in the future. These secondary, indirect, conditions can be just as damaging as those which are caused as a direct medical result of your situation:

Insomnia

Having poor mental health makes it considerably tougher to sleep. Whether it’s because of negative thoughts keeping your brain overly active, or a general feeling of discomfort, a lack of sleep leads into a vicious cycle which can get worse if it’s not addressed.

Fatigue

A natural by-product of finding it harder to get to sleep? A constant feeling of fatigue and a lack of energy. Feeling groggy is a direct result of a poor state of mind, but it’s a common side-effect if you’re either not getting enough rest, or your brain is overactive.

Irrationality

It’s often the case with symptoms of mental health that one negative trait leads into the next. If you’re fatigued, there’s a high chance your brain will stop thinking things through logically. We sometimes call this “brain fog”. That means irrational thinking will creep into your daily life, potentially leading to poor decision making.

Productivity

A lack of both mental motivation and physical energy will have a direct impact on your productivity. Whether it’s carrying out tasks around the home or in a more professional sense, you’ll struggle to be as effective as you once were.

The toll the menopause takes on the mood and attitude of those experiencing it can be damaging. It’s important to get the help and support you need if you start to notice your mental health slipping.

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CHAPTER 04

Treating male menopause

There are several ways to combat the negative effects of male menopause. This section discusses both what you can do yourself, as well as the medical treatment you might be able to receive.

Testosterone replacement therapy

As we’re now well aware, it’s a lack of testosterone which plays a direct role in triggering the male menopause. As such, one of the best ways to counter the problem is by receiving dedicated testosterone replacement therapy.

The process is often relatively straightforward. The patient will be sent a test kit, which they can use to take a blood sample. This is sent back to the therapy provider, who will assess whether or not treatment is needed.

This will often be administered in the form of a gel or injection. There are lots of benefits to receiving this kind of treatment:

  • Increased muscle strength and size
  • Better concentration and drive
  • Lowered level of anxiety
  • A deeper and more stable voice
  • Greater assertiveness

Treatment will only be offered if a clinical professional believes your levels are low enough to justify the introduction of additional hormones.

Getting treatment is a big step, but sometimes a necessary one. That said, there are other ways to lessen the impact of a testosterone deficiency.

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One of the best ways to counter the problem is by receiving dedicated testosterone replacement therapy.

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Finding a healthy diet

Much like with everything in life, finding a well-balanced diet is key to battling the effects of male menopause. A healthy diet can reduce body fat levels which reduces the amount of testosterone converted into oestrogen.

Vitamin D and Zinc are widely considered to be the most important nutrients for triggering the growth of testosterone. As such, consuming foods which are high in them is the best way to increase your levels if you have a deficiency.

Examples of some of the best additions to your diet to achieve this include:

For Vitamin D

Salmon

Spinach

Eggs

For Zinc

Lean animal protein

Oysters and other shellfish

Different types of nuts

Raw milk or cheese

Figs

Think about getting creative with recipes, and try to incorporate a few of these into meals you’re having every day. Fortunately, there are quite a lot of ingredients to choose from.

Adding these basic ingredients to your daily meals will help to ensure your body has the nutrients required to produce testosterone properly.

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Vitamin D and Zinc are widely considered to be the most important nutrients for ensuring normal levels of testosterone production.

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Getting the right level of exercise

No good diet is complete without also changing up how you approach physical exercise. As we’ve seen, testosterone is a key factor in being able to efficiently work your body.

But what happens when you’re lacking the hormone needed to do this? Here are some exercises and routines which are great ways to help encourage the development of testosterone.

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Cardio

This type of workout keeps your heart healthy, while also encouraging the growth of some muscle groups. This is particularly helpful if additional weight gain has become a factor in your male menopause journey. Common forms of cardio include running, walking, cycling and swimming.

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Strength training

Owing to the risk of lowered bone density during male menopause, strength training is also highly recommended. Simple workouts with dumbbells at home will do the trick, or you could even try heading to the gym.

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Yoga

This not only helps with staying loose and free, but also helps to calm the mind. There are several online learning tools you can follow, or again you could head out to join a professional teacher for a proper class.

Exercise is a fantastic way to reduce body fat, which in turn increases the level of testosterone in the body. Try introducing it casually at first, and then increase the levels once your body gets more used to it.

Do you feel like you’re experiencing any of the symptoms associated with a drop in testosterone? Make sure to check if you need treatment. Your body and mind will thank you for it.

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Medically reviewed by

Dr Chris Airey Medical Director

This resource has been medically reviewed for accuracy by Dr Airey on 6th Aug 2020

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CHAPTER 05

Secondary Reading

Have you been inspired to find out more about the male menopause? Be sure to check out these other sources to help expand your knowledge of this niche subject even further.

Do you think you might be experiencing the male menopause? You can find out if you suffer from the main symptoms with our questionnaire

https://www.optimale.co.uk/low-testosterone-test-adam-questionnaire/

The NHS aren’t convinced about the legitimacy of the male menopause, but they do provide detail on it

https://www.nhs.uk/conditions/male-menopause/#:~:text=The%20%22male%20menopause%22%20(sometimes,occurs%20in%20the%20female%20menopause.

This essay from the US National Library of Medicine discusses the existence of the male menopause

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070997/