Is "Male Menopause" Real?

Most people are familiar with menopause – the milestone that marks the end of a woman’s menstrual cycle and a significant drop in the production of the sex hormones, estrogen and progesterone. But do men experience a similar change as they age?

“What’s less commonly known is that men experience a similar age-related drop in the production of the sex hormone testosterone,” says University Hospitals Urology Institute urologist, Nannan Thirumavalavan, MD. “Often incorrectly called ‘male menopause’ or ‘man-o-pause,’ this condition is more accurately known as testosterone deficiency, low testosterone or hypogonadism.”

The Importance of Testosterone

Made in both men and women, testosterone is a hormone mainly produced in the testicles and ovaries. Naturally found at much higher levels in boys and men, testosterone functions as the major sex hormone and plays many important biological roles, including:

• Development of the penis and testes
• Deepening of the voice during puberty
• Growth of facial and pubic hair during puberty
• Regulating muscle size and strength
• Regulating bone growth and strength
• Developing and regulating sex drive (libido)
• Activating sperm production

When Testosterone Levels Decline

Testosterone deficiency occurs when a man’s body does not make enough of this important hormone. The deficiency can occur at any age, but it’s much more common in older men.

“To give you a sense of how age is involved,” says Dr. Thirumavalavan, “less than 10 percent of all men younger than 50 have testosterone deficiency. In contrast, nearly half of men over the age of 80 have low testosterone.”

While some symptoms of low testosterone are similar to those experienced by menopausal women, the conditions are different in a few critical ways. For many women, menopause appears abruptly, with many significant biological changes occurring within one or two years. In the case of men, a gradual decrease in testosterone levels and the onset of related symptoms tend to take place over a much longer period of time.

As a man’s testosterone levels drop, he may experience certain symptoms, some of which overlap with those experienced by women during menopause. Common symptoms of testosterone deficiency include:

• Fatigue
• Weakness
• General lack of enthusiasm or energy
• Depression and moodiness
• Low libido and other sexual problems
• Poor concentration and short-term memory
• Decrease in muscle mass
• Increase in body fat
• Difficulty sleeping (insomnia)

Although testosterone levels naturally decrease as men age, men are unlikely to notice any changes in their 30s and 40s. Symptoms of low testosterone are more likely to show as men hit their late 40s and early 50s.

When to Get Your Testosterone Levels Checked

Your primary care doctor or another healthcare provider may order a blood test if you have symptoms of testosterone deficiency. The American Urological Association also recommends testosterone testing for men with certain conditions, including diabetes, a history of unexplained anemia, bone density loss, pituitary gland dysfunction and exposure to chemotherapy.

“Before we diagnose and treat testosterone deficiency, we have to verify a patient’s levels by checking them a few times on separate days,” says Dr. Thirumavalavan. “Testosterone levels fluctuate throughout the day. Because of this, we like to have men get tested during the morning, since testosterone levels tend to be the most consistent within 30 minutes or so of waking.”

Treatment for Low Testosterone

Once low testosterone levels are confirmed, Dr. Thirumavalavan says the first step is lifestyle changes — namely making improvements in your diet, exercise and sleep. Often, adjustments in these areas can reduce or eliminate symptoms of testosterone deficiency and even increase blood testosterone levels.

Poor sleep quality – especially when caused by sleep apnea – is often associated with low testosterone. “If a patient with low testosterone has a chronic snoring problem or wakes up frequently in the middle of the night, we will likely refer them to a sleep medicine doctor for a sleep study, especially since sleep apnea causes other health problems,” Dr. Thirumavalavan says.

If lifestyle changes don’t help, Dr. Thirumavalavan talks to his patients about testosterone replacement therapy.

Benefits of Testosterone Replacement Therapy

Often effective for reducing and managing the symptoms of low testosterone, testosterone replacement therapy is available in multiple forms, including:

• Self-administered injections
• Topical gels
• Pills
• Nasal sprays
• Pellets put under the skin of the hip that slowly dissolve over a period of three to six months

Testosterone replacement therapy is generally considered safe. The therapy is particularly effective for helping men – both those with and without testosterone deficiency – improve their sex drive and overall satisfaction with sex.

“In fact, low testosterone is the first thing we check for in men with low libido,” says Dr. Thirumavalavan.

Limitations of Testosterone Replacement Therapy

Though considered to be safe, testosterone replacement therapy isn’t suitable for everyone. Men who have a history of prostate cancer should discuss the risks and benefits of the therapy with their doctor. Testosterone doesn’t cause prostate cancer, but it can accelerate the growth of prostate cancer cells.

The therapy also affects fertility. “Some men with testosterone deficiency and fertility problems may think they’ll be able to raise their sperm count by fixing their testosterone levels. However, this is typically not the case,” says Dr. Thirumavalavan. “In fact, when you take testosterone therapy, your brain senses higher testosterone levels and stops sending certain signals to the testicles. As a result, men who take injectable testosterone often experience steep drops in their sperm counts, with some going all the way down to zero.”

Dr. Thirumavalavan points out that testosterone is often just one piece to the puzzle when it comes to men’s often complex sexual and reproductive health issues. “Libido is more complicated than just the presence or absence of a single sex hormone. Men also need a certain level of estrogen in their bodies to maintain a healthy libido. What’s more, there’s a huge psychological component to issues like low libido and erectile dysfunction, regardless of whether testosterone levels are normal or not.”

For this reason, Dr. Thirumavalavan recommends complementary psychological help for men with low libido, erectile dysfunction and related issues, such as the services offered by Robert Brian Denton, PsyD, a psychologist with the University Hospitals Urology Institute who specializes in addressing the role of mental health in men’s sexual health.

Related Links

The expert urologists UH Urology Institute have advanced training and expertise in a wide range of urology services and procedures. The Institute’s Male Reproductive & Sexual Health Division offers leading-edge treatments to help restore fertility and sexual health in men.