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Male Menopause: Is it for real?

The phrase male menopause is sometimes used to describe the physical and psychological changes that men go through beginning around age 40.  Although male testosterone levels generally decrease over time, borrowing the term male menopause to describe it is a mistake.

The word starts with m-e-n, but the men in menopause doesn't refer to gender - it refers to menstruation.  So, because men don't menstruate, using the term menopause, which refers to the time when menstruation stops, is inaccurate.  Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, MN, prefers the term andropause.  "There needs to be a distinction because we're dealing with two different situations," he says.  "In women, ovulation ceases and female hormone production plummets over a relatively short time frame.  In men, there's a gradual decline in the production of male hormones."

Other terms for this stage include male climacteric, viropause, and low testosterone syndrome.  What to call it is just the beginning of the debate.  The bigger question is whether gradually declining testosterone levels are natural and protective, or a condition to be considered for treatment.  In fact, the core of this controversial issue is whether or not to treat it.

Male Hormones Over Time

In general, older men have lower testosterone levels than younger men.  After age 30, testosterone levels may start to slowly ebb.  But unlike the cessation of menstruation, which signals the end of childbearing for women, there is no corresponding reproductive event for men.  "While every woman goes through menopause, not every man ends up with low testosterone levels," says Dr. Nippoldt.  "Andropause is not associated with complete deficiency of gonadal (reproductive organ) function."

The decline in testosterone is slow and progressive.  And unlike estrogen in women, blood levels of testosterone in men generally remain within the normal range with increasing age.  Typically men can reproduce into their 70s.  The rate of testosterone decline also varies greatly among individuals.  Only about 5% of older men have a testosterone level below what's considered normal for young men.

There is a disease of the testes or pituitary gland, which controls the testes, which can cause lower testosterone levels at any age.  Called hypogonadism, it can lead to such medical conditions as thinning bones, sexual dysfunction, and decreasing muscle mass.  In hypergonadal men, treatment with testosterone is beneficial.  It is unclear, however, whether it's worthwhile to restore testosterone levels lowered by normal aging back to those of younger men.

Studies examining testosterone replacement therapy (TRT) and normal aging have not shown consistent benefits.  TRT is not risk-free.  In aging men, testosterone treatment may:

  • stimulate non-cancerous (benign) growth of the prostate
  • unmask prostate cancer - men with prostate cancer should not take testosterone
  • aggravate sleep apnea - a brief but repeated suspension of breathing during sleep
  • stimulate excess blood production

Andropause vs. Midlife Crisis

It's important to make a distinction between andropause and a midlife crisis.  Andropause describes the physical changes men go through at midlife.  A midlife crisis is what happens when men have trouble dealing with those and other changes.

Signs and symptoms of low testosterone include:

  • decreased beard growth
  • increased fat
  • decreased muscle and bone mass
  • hot flashes
  • irritability
  • mood swings
  • difficulty concentrating
  • depression
  • fatigue
  • breast enlargement or tenderness
  • erectile dysfunction

Illness or medications also can cause these signs and symptoms.  If you experience some of these signs and symptoms, talk to your doctor to see if you have low testosterone and determine the cause.  Many men face other issues at midlife - caring for aging parents, facing mortality, and feeling stuck in a career.  They deal with these life changes in many ways.

"A midlife behavior change may well be very difficult for some men, no matter the cause," says Donald Williams, Ph.D., a clinical health psychologist at Mayo Clinic.  "Others take changes in stride."  To avoid being overwhelmed by midlife, be aware of what's going on and stay connected.  "Recognize changes and try to deal with them constructively," says Dr. Williams.  "Though reaching out and discussing emotions can be difficult for men - even during good times - social support is helpful.  If needed, obtain professional help for depression or other difficulties in coping."

The Debate Continues

Label it male menopause, andropause, or don't label it at all.  There is no question that men face emotional and physical challenges as they age.  Changes at home, at work, and within their bodies affect men's general health.  A severe decline in testosterone may be a reason to take supplemental testosterone.  But it remains unclear whether restoring the testosterone levels of youth benefits older men.