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What is the Male Menopause?

What is The Male Menopause?

Just as the fairer sex sees a drop in oestrogen levels after the menopause, the male menopause (also known as the Andropause) is a term sometimes used to talk about a decrease in testosterone levels as men get older.

Many men experience symptoms similar to women experience during the female menopause, at a similar time in their lives – this is why it is called the ‘male menopause’.

Both can have a serious effect on people’s lives, affecting their sexual, physical and mental health

Whilst the menopause in women is a well-known phenomena, men’s issues with hormonal health are less commonly discussed.

Here we will look at whether the male menopause / andropause exists and if so, what causes it. We will focus on:

  • The main symptoms of the so-called ‘male menopause’
  • How and where to get diagnosed if you think you are suffering from the symptoms,
  • How to obtain effective treatment from specialists.

But first, we need to understand the hormone behind the male menopause – testosterone.

What is testosterone? 

Testosterone is a hormone or chemical messenger produced mainly by the testes in men and in smaller amounts in women.

It is considered a sex hormone due to its effects on the sex organs and production of male characteristics and behaviours. It has a wide range of effects on the body, the mind, behaviour, fertility and development.

It is extremely important for male well-being and physical health, which makes it even more surprising that some parts of the medical community are often so against treating it effectively. This hormone, testosterone, is the culprit in the male menopause.

Testosterone Chemical Structure

Is the male menopause a real thing?

In biological terms, no there isn’t such thing as the male menopause. However, some men undergo changes to their hormone levels which are very similar to those seen by menopausal women.

This means that the changes seen around the same age are often referred to as the Male Menopause…

The Difference between the Male Menopause and the Female Menopause

In men, testosterone levels drop slightly every year after 30. As well as this, the levels of SHBG (sex hormone-binding globulin) increase every year.

Add to this the fact that the whole population’s testosterone levels are dropping year on year and together this leads to a gradual decrease in testosterone levels which can mean low testosterone and menopause-like symptoms.

However, testosterone levels do not usually drop suddenly as oestrogen levels do in the female menopause.

In women, oestrogen levels drop dramatically after an age where the body can no longer reproduce. This has evolved as a mechanism to move an older woman’s role away from child-bearing into the support of her grandchildren. In men, this same pressure doesn’t exist but testosterone levels may decline in general.

 

What are the Similarities between the Male Menopause and the Female Menopause?

They occur at a similar time in life

This gradual drop in testosterone levels after the age of 30 can lead to a reduction which causes low testosterone symptoms in men. These often occur at the same age as women experience their menopause. This is why it is often called the male menopause.

They can be treated with hormone replacement therapy.

They have similar signs and symptoms.

What are the signs of male menopause?

  • low sex drive/libido
  • low energy
  • poor sleep
  • sexual dysfunction (erection issues in men, vaginal dryness in women)
  • low mood
  • sweating/ hot flushes
  • joint pain
  • reduced bone density

     

Both the female and male menopause can lead to similar symptoms. There is some cross-over here as both have an effect on the hormonal system.

Whilst the male menopause mainly affects testosterone, this has a knock-on effect on oestrogen levels as in men oestrogen is converted mainly from testosterone. In the female menopause, symptoms are primarily related to reduced oestrogen levels, although testosterone may also be an issue.

How are the male and female menopause diagnosed?

Both male and female menopause is diagnosed by a combination of blood tests and symptoms.

Clinicians will look for the signs listed above combined with low blood test results and patient history to decide whether there is a hormonal cause.

Male testosterone levels before TRT

How are they treated?

In both men and women, hormonal levels do not return to normal on their own.

As a result, the most effective treatment is with hormone replacement therapy. As the name suggests, the low levels of hormones are replaced with a medication containing the same hormone at higher levels. This brings patients back to their normal levels and relieves symptoms.

What else other than male menopause could it be?

Some of the symptoms of male menopause or low testosterone are the same as other conditions which can occur around the same age.

Depression and anxiety can occur despite normal testosterone levels. These cause low mood and can affect energy levels and libido.

Stress often increases around this age due to increased responsibility at work or men having a mid-life crisis.

Obesity or poor nutrition can lead to hormonal disruption and a lot of the signs mentioned previously.

All of these factors can actually make hormone levels worse, so there is often a chicken and the egg type situation. This can mean it isn’t obvious which is the initial issue.

How can I tell what is causing my symptoms?

The easiest and quickest way to find out whether low testosterone (male menopause / andropause) is causing your symptoms is to order a blood test.

This will quickly help you determine whether you have low testosterone levels that need treatment.

Make sure you get a test which covers total and free testosterone levels such as the one sold on our website. The free testosterone level can be much lower than the total testosterone in older men with a high SHBG. This is often not tested by many labs and the NHS.

Testosterone Levels by Age

‘Total testosterone levels are affected by alterations in SHBG that occur in obesity, old age, diabetes mellitus, hyper- and hypothyroidism, and acromegaly, and in men taking certain medications. Accurate and reliable assays for free or bioavailable testosterone measurements usually are not available in local laboratories, and these tests should be performed in a reliable reference laboratory.’ Cheung et al., (2015) Testosterone level in men with type 2 diabetes mellitus and related metabolic effects: A review of current evidence. J Diabetes Investig. 6(2): 112–123.

Why is the male menopause often ignored when the female menopause is known about and treated?

A lot of men complain that they are not taken seriously by their GP when they complain of male menopause symptoms.

This is something we hear about almost daily from patients. Doctors tell them that they ‘are just getting old’ they are ‘depressed and need anti-depressants’ or even that they are going through a ‘mid-life crisis’.

This can lead to men feeling that they aren’t being listened to.

Most doctors see TRT / testosterone replacement therapy for male menopause as being dangerous or ineffective. If well-controlled and with proper support then TRT is safe for the majority of men. Recent research indicates that men on TRT have a reduced all-cause mortality compared to men with low testosterone who didn’t get treatment!

Unfortunately, testosterone still has a stigma attached to it and some doctors are not keen to prescribe TRT due to some of its side-effects. Despite there being evidence that TRT is beneficial for heart health and reducing the risk of diabetes it is often ignored as a treatment. This is mainly due to the negative side-effects that can occur when TRT is not prescribed properly.

Age corrected testosterone levels for male menopause

Average testosterone levels by age

SOURCE: Vermeulen A. (1996) Decreased androgen levels and obesity in men. Ann Med. 28(1):13‐15. https://pubmed.ncbi.nlm.nih.gov/8932500/

SHBG levels chart

You can see that SHBG (sex hormone binding globulin), which attaches to testosterone and makes it unable to bind to receptors in the body, rises with age. This is one reason why a man’s free testosterone drops so much with age and can lead to male menopause-like symptoms. And it’s another good reason to always have free testosterone checked when worried about low testosterone symptoms!

DHEA is another testosterone precursor (testosterone is produced from it) that drops massively with age. It is responsible for many male traits and physical changes in the body. It has been shown to increase strength and reduce body fat levels in men. Many men take it as an anti-ageing supplement (there is limited evidence for anti-ageing effects but it may help with weight-loss).

With lower testosterone levels DHEA also reduces significantly and can lead to male menopause symptoms.

More specific signs and symptoms (these symptoms are closely linked to lower than normal male testosterone levels)

  • Reduced sexual desire (libido) and activity
  • Decreased spontaneous erections/morning erections
  • Breast discomfort, gynaecomastia
  • Loss of body hair axillary (armpit) and pubic hair, reduced shaving frequency
  • Small or shrinking testes
  • Low or zero sperm count
  • Height loss, low trauma fractures and reduced bone mineral density
  • Hot flushes, sweats

Testosterone and oestrogen play a huge role in the body, if deficient then there are numerous negative effects to a man (or woman’s) overall health and wellbeing.

Signs of Low Testosterone

Less specific signs and symptoms (these may indicate low testosterone levels/male menopause or a different condition)

  • Decreased energy, motivation, initiative and self-confidence
  • Brain fog
  • Poor lipid profile
  • Feeling depressed or anxious, depressed mood, dysthymia
  • Poor concentration and memory
  • Sleep disturbance, increased sleepiness
  • Mild anaemia
  • Reduced muscle bulk and strength
  • Increased body fat percentage
  • Reduced work and physical performance

Get treated!

If you are noticing several of these symptoms then it is definitely worth getting your testosterone blood results tested as you may be suffering from the ‘male menopause’ or low testosterone. It is a simple, quick test that you can do at home.

You can sometimes get these completed by your GP (make sure you request free testosterone to be tested) or we can organise tests for you. Read more on where to get treated.

There is the choice of at-home blood tests and venous tests done at a local clinic.

We test for Total Testosterone, Free Testosterone, Albumin, SHBG and Free Androgen Index (FAI) levels at an extremely competitive price (our test is £44.99 compared to £79+ elsewhere).

Benefits of normal testosterone levels

  • Generally healthier
  • Less anxiety
  • Mental agility / reduced ‘brain fog’
  • Muscle strength and size increases
  • Improved bone density
  • More assertive and confident
  • Better concentration and drive
  • Improved outlook on life, better mood
  • Reduced IBS and Crohn’s symptoms
  • Deeper more stable voice
  • Better sleep

I have personally noticed 9 out of 11 of these since starting testosterone replacement therapy. You can read more here.

Conclusion

The male menopause may not be exactly the same as the female menopause. However, big decreases in available testosterone are becoming more and more common in older men. If you are starting to notice some of the symptoms above then it is really important that you get tested.

In the modern world where testosterone levels are dropping year by year, your health and happiness depend on having good levels.

Whilst testosterone often gets bad press – it improves male mental and physical health when at optimal levels. It can improve your relationships and social life. Unfortunately, it is often considered as normal for older men to have low testosterone levels and it is seen as a fact of getting older. This is not true and you shouldn’t have to live with these symptoms.

If you are interested in learning more then please contact us using the form below and we would be happy to answer any questions you might have!

This article was updated and reviewed for accuracy on 23rd May 2020.

Dr Chris Airey

Dr Chris Airey

Medical Director

This article has been medically reviewed for accuracy by Dr Airey on 12th September 2020.

Dr Chris Airey is a fully registered UK doctor with the GMC (General Medical Council) Reference No: 7490533.
He trained at the University Hospital Southampton and graduated as a Doctor with a joint Bachelor of Medicine and a Bachelor of Surgery, plus a Masters in Medical Science, completing his research project in the Medical Neurosciences Department.
He is undertaking a Master of Science course in Endocrinology and is a member of the European Society for Sexual Medicine, and the Androgen Society.
He has personal experience with taking Testosterone Replacement Therapy and is a pioneer in UK treatment protocols for Testosterone Deficiency Syndrome.

Please contact us with any questions using the form below