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Understanding Andropause: The Male Menopause

Andropause can be considered as the male equivalent of menopause.1 It occurs in elderly males when their bodies produce reduced levels of testosterone, leading to alterations in mood, energy, and overall health. It diverges from women’s menopause since it does not impede their ability to conceive. Andropause may occur as a result of harmful behaviors or a medical disease known as late-onset hypogonadism. Physicians can provide specialized medications to restore hormonal equilibrium in the body, however these treatments may result in adverse reactions. Consulting a physician is crucial if an individual suspects they are experiencing symptoms of andropause.

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It is commonly known that women go through menopause, a stage in their lives during which their bodies go through major hormonal and physical changes, and they stop having monthly menstrual periods. You may be wondering if there is a male equivalent of menopause. Continue reading to learn about a condition called andropause, also known as the ‘male menopause.’

This article is an overview of andropause, including symptoms and causes. We will also discuss treatment options, such as testosterone replacement therapy (TRT) and hormone replacement therapy (HRT).

What Is Andropause?

Andropause is a condition that occurs in aging men.2 The word “andropause” is a combination of the Greek words “andras” (meaning human male) and “pause” (meaning to cease).

It causes testosterone levels to drop, leading to decreased feelings of general well-being and sexual satisfaction.

Andropause was first written about in a medical journal in a 1939 article titled “The Male Climacteric” in the Journal of the American Medical Association (JAMA). Its author, AA Werner, noted that some of the symptoms included nervousness, reduced potency, and decreased libido.

older man showing something to his wife on a tablet

We will take a more in-depth look at the symptoms of andropause later in this article. Andropause has been called by many names since its discovery, including:

  • Male climacteric (Werner’s original term for this condition)
  • Aging male syndrome
  • Androclise
  • Androgen decline in aging males (ADAM)
  • Male menopause
  • Late-onset hypogonadism (LOH) (the most current term for this condition)

Menopause, which happens to all women, has a specific timeline and results in complete infertility. In contrast, andropause comes on subtly, progresses slowly, and does not lead to complete infertility. (Exceptions include men whose testes have lost functionality because of an accident or disease, as well as men who have undergone medical or surgical sterilization because of severe prostate cancer).

What Are The Symptoms of Andropause?

Symptoms of andropause can affect men physically, psychologically, and sexually.

The original list of andropause symptoms identified by Werner was:

  • Decreased libido
  • Depression
  • Fatigue
  • Hot flushes
  • Irritability
  • Memory problems
  • Nervousness
  • Reduced potency
  • Sleep disturbances

Other symptoms of andropause may include:

  • Decreased bone density
  • Decreased motivation
  • Decreased testicle size
  • Difficulty concentrating
  • Erectile dysfunction
  • Feeling physically weak
  • Gynecomastia (development of breasts)
  • Increased body fat
  • Infertility
  • Loss of body hair
  • Low self-confidence
  • Reduced muscle mass
  • Swollen or tender breasts

What Causes Andropause?

Andropause is caused by low testosterone levels in older men, which itself can be caused by either personal or lifestyle issues or late-onset hypogonadism.

Personal or lifestyle factors that can cause low testosterone levels that lead to andropause include:

  • Anxiety
  • Depression
  • Heart problems
  • Lack of exercise
  • Lack of sleep
  • Low self-esteem
  • Midlife crisis
  • Overconsumption of alcohol
  • Poor diet
  • Smoking
  • Stress

Late-onset hypogonadism is estimated to affect 10% of men above 50 years old, but if you do have it, it can cause symptoms of andropause. This condition reduces or completely stops hormone production in the testes. You are more likely to develop late-onset hypogonadism if you are obese and/or if you have type 2 diabetes. To determine if you have late-onset hypogonadism, talk to your doctor about your symptoms and have them do a blood test to check your testosterone levels.

How Is Andropause Treated?

Treatment for andropause may involve hormone replacement therapy (HRT) or testosterone replacement therapy (TRT).

HRT rebalances your body’s hormone levels by replacing testosterone and other hormones, including dehydroepiandrosterone (DHEA), estrogen, and progesterone. The DHEA hormone helps increase the production of other hormones, such as estrogen and testosterone. Although estrogen and progesterone are often viewed as female hormones, they are also important for men.

happy older couple looking at a laptop

Estrogen helps men and women balance mood and maintain bone strength. Like DHEA, progesterone helps increase the production of other hormones. Also, progesterone precedes testosterone, counterbalances estrogen’s effects in men, and progesterone declines as estrogen increases during andropause.3

Conditions that can be treated with HRT include:

  • Andropause
  • Hormonal imbalances
  • Menopause
  • Perimenopause

HRT is generally safe, but there are some possible risks and side effects, and it is not right for everyone. Many HRT risks and side effects overlap with andropause symptoms.

HRT risks and side effects may include:

  • Decreased bone density
  • Decreased libido
  • Decreased testicle size
  • Depression
  • Difficulty concentrating
  • Erectile dysfunction
  • Fatigue
  • Feeling physically weak
  • Hot flushes
  • Increased body fat
  • Increased risk of heart disease
  • Increased risk of stroke
  • Increased risk of type 2 diabetes
  • Less intense orgasms
  • Loss of body hair
  • Memory problems
  • Reduced ejaculation
  • Reduced muscle mass
  • Shortened penis length
  • Swollen or tender breasts

HRT is a versatile treatment option for people of all ages and genders who are experiencing hormonal imbalances.

Rather than replacing multiple hormones like HRT does, TRT only replaces testosterone.
There are many forms of TRT available. You and your doctor will work together to determine the best delivery method based on your preferences, medical history, and doctor’s recommendation.

Testosterone replacement therapy is available in the following forms:

  • Gels
  • Injections
  • Patches
  • Pellets that are implanted underneath your skin
  • Oral supplements

TRT is useful in treating hypogonadism and low testosterone levels. Unlike HRT, TRT is only available for men.

There are some risks and side effects associated with TRT. Short-term side effects may include:

  • Acne or oily skin
  • Changes in cholesterol levels
  • Decreased flow of urine
  • Decreased frequency of urination
  • Decreased testicle size
  • Development or worsening of sleep apnea
  • Hair loss
  • High blood cell counts that could increase your risk of developing blood clots
  • Increased aggression and irritability
  • Mood swings
  • Reduction in sperm count, which may lead to reduced fertility
  • Swollen ankles due to fluid retention
  • Swollen or tender breasts

Long-term side effects of TRT may include:

  • Cardiovascular problems such as heart attack and stroke
  • Hip fracture caused by osteoporosis
  • Increased risk of fatal heart attack
  • Polycythemia (an increase in hemoglobin levels due to a rise in red blood cells)
  • Worsening urinary symptoms

Last Words

Andropause causes older men to have low testosterone levels, which can lead to a wide range of physical, psychological, and sexual symptoms. Low testosterone levels can also be caused by lifestyle factors such as smoking and stress or a disorder called late-onset hypogonadism, which causes slowed or stopped hormone production in the testes.

Andropause can be treated with HRT or TRT. Both HRT and TRT replace testosterone, but HRT also replaces the hormones DHEA, estrogen, and progesterone. HRT can be given to anyone with a hormone imbalance, regardless of age or gender. TRT is only for men. HRT can be used to treat andropause and hormone imbalances in men, while TRT can be used to treat hypogonadism and low testosterone levels. Both treatment options may cause certain side effects.

Talk to your doctor if you think you may be dealing with andropause or if you have been diagnosed and want to try HRT or TRT treatment.

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References

[1] Nandy PR. - Male Andropause : A Myth or Reality;

[2] Singh P. - Andropause: Current concepts;

[3] Ghoumari AM. - Roles of Progesterone, Testosterone and Their Nuclear Receptors in Central Nervous System Myelination and Remyelination;