Male Menopause – Andropause
In women, menopause is the time in the women’s life that menstruation and ovulation ends as a result of decreased hormone production. It is diagnosed after a lady has not had a menstrual period in 12 months. Menopause usually occurs in a lady when she hits her late 40s or 50s, but can vary from one female to another. However, this occurs for all females eventually.
The term “male menopause” or andropause refers to age-related declining testosterone levels. In contrast with menopause where all females will eventually experience, the drop in testosterone levels may not occur in all men. In fact, a 50 year-old man can have a higher level of testosterone than say a man in his 30s. Menopause also involves a complete shutdown of reproductive capability in females, but a man in his 70s can still father a child. While it is still possible for a female to get pregnant in her 70s, it is exceedingly rare. Because of these facts, some people doubt whether male menopause truly exists.
However, there are a few things we know. Testosterone levels can vary greatly among men but in general, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average.
Other names for this condition are testosterone deficiency syndrome, androgen deficiency of the aging male and late-onset male hypogonadism.
What are the key signs and symptoms of andropause?
The signs and symptoms of andropause is because of a drop in testosterone levels in an aging male.
A person with andropause may experience a decline in sexual function. This might include reduced libido or sexual desire, erectile dysfunction, fewer spontaneous erections both during the day and night, and infertility.
Some physical changes may occur, including reduced muscle bulk and strength, increased body fat, and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Some may experience hot flashes. Others may report decreased energy levels. The testes might become smaller as well.
Emotional changes may occur. Some examples include a decrease in motivation or self-confidence. Mood issues such as feeling sad or depressed may occur. Some may have cognitive issues such as trouble concentrating or remembering things. Some people may have difficulty sleeping as well.
What are some of the aging-related hormone changes in men? Does this mean (the person) has andropause?
As mentioned above, the primary hormonal change in men is a decrease in testosterone levels. Other hormones such as growth hormone, prolactin and IGF-1 may decrease. Estradiol levels may decrease as well, but in some older males, due to increased fat mass, they may have increased estradiol levels which offsets the natural decline in estradiol levels. A hormone that tends to increase with age is the thyroid stimulating hormone (TSH). Gonadotrophin levels also tend to increase in response to dropping sex hormone levels.
For the sake of this article, we would just be focusing on testosterone. As doctors, we do not just look at the testosterone level of the patient. We also take into account what symptoms the patient is presenting with. A gentleman may have a low testosterone level and not be bothered at all about it as it may not present with significant symptoms in him. In another gentleman, with a low-normal testosterone level may present with a whole barrage of symptoms that are affecting his life. In these 2 cases, we are more likely to diagnose and treat the second gentleman.
It is important to note that decreased levels of testosterone may sometimes be attributed to other causes such as medications such as steroids or psychiatric medications, medical procedures such as chemo or radiotherapy, other medical conditions such as kidney conditions, tumours and hemochromatosis, inflammatory conditions such sarcoidosis, and histiocytosis, and chronic infections such as HIV and tuberculosis. Your doctor will run through your past medical history when evaluating your symptoms as well.
Do I need treatment for andropause?
Whether or not you need treatment for andropause depends on your symptoms, and to what degree your symptoms are affecting your work, relationships and life.
Testosterone levels can be easily measured with a simple blood test. Other hormones and other blood tests are usually conducted at the same time. The best time to come for a blood test is in the morning when the testosterone levels are at its highest. No fasting is necessary for the blood test.
For men with truly low testosterone levels, testosterone replacement therapy (TRT) tends to result in the reversal of the symptoms mentioned above, improved quality of life and has health benefits as well.
What are the treatment options?
Lifestyle changes are always recommended for people presenting with andropause. Exercise and weight loss, stress reduction, adequate sleep and a healthy lifestyle and diet can sometimes raise your testosterone level marginally.
In conjunction with that, we can do TRT as well, where we can replace testosterone through pills, injections, patches or gels. The dose and frequency of delivery of testosterone varies from person to person. Doctors will usually do regular blood tests to look out for complications and to tailor the correct dose for you.
What are the side effects and complications?
While people with true testosterone deficiency report marked improvement in symptoms, TRT is not without risk. TRT can contribute to sleep apnea, stimulate noncancerous growth of the prostate and stimulate growth of existing prostate cancer. Testosterone therapy may also increase the risk of heart attack and stroke and contributes to the formation of blood clots in the veins. It can also cause acne or other skin reactions, limit sperm production, cause testicle shrinkage and enlarge the breasts. It is therefore important to weigh the risks versus the benefits in starting TRT, and monitor for complications should any arise.
While ageing is inevitable, andropause and its symptoms can be managed with improved quality of life as a result. Speak to your doctor to see if you do have the symptoms mentioned above and if your testosterone levels are truly low, to see if TRT is suitable for you.