Is “Male Menopause” a Real Condition?

There is some disagreement among experts regarding the term “male menopause.” A number of experts believe that it is not a real condition, but simply reflects the effects of aging, while other experts feel it is a real condition that should be treated. Though many men definitely experience hormonal changes as they get older, these changes, most commonly in testosterone levels, are usually more gradual than the changes seen with female hormones in female menopause.  Many experts prefer the term “andropause,” “low testosterone (Low T),” or testosterone deficiency over “male menopause.”

While there is disagreement over the exact terminology that should be used, what is real is that many men gradually become aware of symptoms that can be correlated to the lower blood levels of testosterone. These symptoms can become more obvious and more troubling as men get older. What is also real is that low testosterone has been associated with an increased risk of death.

What Are the Functions of Testosterone in a Man?

During puberty, testosterone is responsible for the development of male characteristics such as increased muscle mass; a deeper voice; hair on the chest, face, and underarms; increased genital size; and development of normal erections. During the adult years, testosterone helps maintain muscle and bone strength and maintains a man’s sexual drive and sexual interest.

What Are the Common Symptoms of Low Testosterone?

The symptoms associated with low testosterone or Low T can be grouped into categories. The Endocrine Society lists the following “red flag” symptoms that should alert someone to the possibility of low testosterone levels:

  • Problems with sexual function that can include erectile dysfunction (ED), decreased desire for sexual activity (decreased libido), and a decrease in the number and quality of erections.
  • Some men may notice smaller testes (hypogonadism). The amount and force of the ejaculate may also decrease. 
  • Emotional problems, including depression, irritability, anxiety, problems with memory or concentration, or decreased self-confidence can occur.
  • Sleep and energy issues occur that may range from problems getting to sleep or staying asleep to unexplained drowsiness, increased fatigue, or a general lack of energy.
  • Body changes can take place—these can include increased belly fat, decreased muscle mass (along with decreased strength and endurance), decreases in cholesterol levels and osteopenia (softening of the bones), and osteoporosis (decreased bone density). 
  • Some men can experience swollen or tender breasts (gynecomastia) or a loss of body hair. Some men experience hot flashes similar to those experienced by women during menopause. 

How Is Low T Diagnosed?

Your physician can diagnose Low T through a combination of a physical exam and a blood test to measure your testosterone levels. He or she may also want to rule out other possible conditions such as low thyroid function, depression, high blood pressure, heart disease, diabetes, or the side effects of medications you may already be taking. Be prepared to undergo a full physical exam, including a genital exam, and to answer a number of personal questions. It is important to give complete answers, because the treatment options will differ depending on your particular set of problems.

The blood test for testosterone is not necessarily the definitive answer—these tests have to be interpreted by your physician, who has to consider your unique situation.  For example, about 30 percent of those tested for testosterone will show low levels on their first test, but when it is repeated, they show normal levels. Also, the most important lab value is the “free” or “bioavailable” testosterone as opposed to the total testosterone—and the bioavailable testosterone is not always easy to measure.

A low testosterone level can be caused by:

  • aging
  • injury to the testicles
  • type 2 diabetes
  • obesity
  • alcoholism
  • medication side effects
  • testicular cancer or the treatments for testicular cancer
  • other hormonal disorders
  • infections such as HIV/AIDS
  • chronic liver or kidney disease

What Are the treatment options?

Treatment depends on the underlying cause of the low testosterone levels. Once other conditions have been ruled out, your doctor may discuss testosterone therapy (TT) with you.  There are many approaches to TT, including injections, patches, topical gels, and oral dosing. TT does have some risks and side effects associated with it. Some of the side effects are:

  • increased swelling or tenderness of the breasts
  • acne
  • swelling of the ankles
  • increased numbers of red blood cells, which may increase the risks of blood clots and heart attacks or strokes

Many physicians are concerned that TT may increase the chances of prostate cancer and are very reluctant to prescribe TT for those who have prostate cancer, who have had it in the past, or who might be considered at risk for prostate cancer. There are a number of studies currently under way to help address these concerns.