Is male menopause real?
Yes and no. Men go through natural hormone decline as they age, but the changes are less rapid and less severe than the hormonal changes experienced by women in menopause. These changes are sometimes called andropause. Andropause is a collection of symptoms attributed to a gradual decline in testosterone levels including fatigue, mood changes, lowered libido and erectile dysfunction.
Andropause is a term used commonly by both experts and lay persons because it retains some similarity to menopause in women. The term “andropause” is not completely accurate, however, because androgen secretion does not cease altogether (as in “menopause” which is a cessation of menstruation).
Andropause, just like menopause, can produce symptoms that are either tolerable or intolerable. For some men, lowered testosterone levels brought on by age aren’t a big deal. For others, the decline can cause symptoms that really do decrease their quality of life. For those men, treatment may be required.
Although the term andropause has become common, there are many labels given to the hormonal changes in aging men. Terms include:
- Andropause
- Androgen Deficiency in the Aging Male (ADAM)
- Partial Androgen Deficiency in the Aging Male (PADAM)
- Aging-Associated Androgen Deficiency (AAAD)
- Male Menopause
- Viropause (named for a decline in male virility)
- Testosterone Deficiency
- Low-T
- Male Climacteric
- Hypogonadism
- Symptomatic Late Onset Hypogonadism (SLOH)
Whatever the term used, it all boils down to a decrease in typically male hormones.
What are androgens?
Structure of Testosterone
Both men and women produce androgens, which are converted to testosterone or estrogen. Testosterone is the most prominent and aggressive androgen. It is produced by the testes in men, and the ovaries in women. Dehydroepiandrosterone (aka DHEA) is an androgen produced by the adrenal glands in all bodies. DHEA can be converted to estradiol (estrogen) or testosterone. Both genders have a combination of the two hormones, however, the levels are highly slanted dependent on which reproductive system you carry around.
Whether male or female, androgens are the kick starter to puberty. They drive reproductive development, hair production, muscle mass, bone density, and traits such as libido and body odor.
What happens when androgen production declines?
Considering the functions outlined above, a decline in androgen production can cause decreased muscle mass, decreased bone mass (osteoporosis), increased and redistributed fat mass, mood changes, and lower libido.
Male androgen production typically starts declining between the ages of 35 and 40 and continues to decline at a rate of 1-3% per year. 1
Prevalence of Andropause
So how many men are affected by this condition? According to the New England Journal of Medicine, approximately 10% of men in their 40s have low testosterone; 25% of men in their 50s; 45% of men in their 60s; 70% of men in their 70s; and further increases in older men.
Contributing Factors
The decrease in testosterone levels in men is a natural occurrence in aging men. In addition, the following conditions may contribute to andropause:
- Diabetes
- Obesity
- Alcoholism
- Emphysema (chronic lung scarring) or chronic bronchitis
- Liver cirrhosis (scarring)
- Chronic kidney disease
- Sleep apnea (stopped or shallow breathing while sleeping)
- HIV-AIDS
- Anabolic steroid use
- Other hormone imbalances
- Long-term use of opioid medications
Symptoms
It’s important to remember that when you start noticing physical or psychological changes as you age, that hormone levels can trigger many symptoms which shouldn’t be treated as separate issues. For instance, if you start feeling depressed, you may go to your doctor to request an antidepressant. But, the depression is only a symptom. By taking an antidepressant, you’re merely treating one symptom, not the underlying cause. Consider your symptoms as a whole over the past year few years and share them with your doctor.
Common symptoms include:
- Low energy
- Reduced libido
- Erectile dysfunction
- Sleep disturbances
- Increased body fat
- Reduced muscle mass and strength
- Thinning skin
- Loss of body hair
- Gynecomastia (development of breasts)
- Depression
- Decrease in motivation or self confidence
- Decreased bone density
- Difficulty concentrating
- Memory issues
Treatments
1. Lifestyle Change
It’s possible that the symptoms you’re experiencing can be relieved through lifestyle changes. Although it’s always advisable to live a lifestyle that includes fresh air, water, sunshine, exercise, sleep, and plant based foods; your lifestyle becomes even more important when health issues arise.
Following are some changes that can help raise testosterone production or decrease the rate at which testosterone levels decline. It can also be helpful to enlist the guidance of a functional medicine practitioner who will look at your lifestyle as a whole and analyze where condition-specific changes should be made. They will also advise you on further treatment options if lifestyle change alone isn’t working.
Increase Exercise
By increasing your activity level, your body will get the message that it needs to produce more hormones to maintain muscle and bone mass. Exercise has also been proven to reduce stress. Stress increases your cortisol levels which negatively impacts sex hormone production. Don’t overdo it, however. Continual endurance exercise has been linked with lower testosterone levels.2,3
Eat a Healthy Diet
It’s not just about eating your fruits and vegetables. There are specific foods that encourage the production of hormones. Key nutrients that promote healthy testosterone levels are vitamin D and zinc. You’ll also want to boost your intake of branch chain amino acids (BCAAs) which consist of leucine, isoleucine, and valine.
Some foods you may want to include in your diet:
- Salmon (vitamin D)
- Spinach (vitamin D)
- Eggs (vitamin D and BCCAs)
- Lean animal protein (BCCAs and zinc)
- Whey protein (BCCAs)
- Oysters and other shellfish (zinc)
- Nuts such as cashews, almonds, and walnuts (zinc)
- Seeds such as pumpkin, squash, pine nuts, and flaxseeds (zinc)
- Beans such as baked beans, kidney beans, and chickpeas (zinc)
- Raw milk, cheese or kefir (zinc)
- Figs (zinc)
- Cruciferous vegetables (help clear estrogen)
Keep in mind that cooking food (especially over-cooking) significantly reduces the number of nutrients retained (like zinc). Also, use monounsaturated fatty acids when cooking, such as olive oil.4
2. Supplements
In some cases, supplementation can have a positive influence on raising testosterone levels. Where nutrients are concerned, supplements are meant to make up for inadequate intake through diet, so primary emphasis should be placed on getting these nutrients through food.
Just like medications, supplements can cause side-effects and interactions with other medications. It’s important to talk with your health care practitioner before adding any of these to your regimen.
DHEA
DHEA (dehydroepiandrosterone) is a steroid hormone produced by your adrenal glands and is the precursor to male and female sex hormones. The supplement form is made from chemicals in wild yam or soy that are converted to DHEA in the laboratory. Our bodies cannot do this conversion, so increasing intake of soy or yams does not increase DHEA levels.
In addition to supporting testosterone production, it has been indicated to relieve depression, improve well-being, increase bone density, among other things. Some studies have indicated that its use comes with potential side-effects and advise against long-term use. Dosage is generally 5-10mg daily for women and 25-50mg daily for men.
Maca
Maca is a root that grows at high altitudes in Peru and is available in many forms. Maca is an adrenal tonic and a sex hormone tonic. It has been associated with improved libido, stress relief, increased energy, increasing sperm count (improving fertility), and helping with erectile dysfunction (ED). A standard dose typically ranges from 1,500 to 3,000 mg per day.
Vitamin D
Research has indicated that Vitamin D has a positive impact on testosterone levels, however the reason is unclear. Therapeutic doses typically range from 4,000 to 5,000 IUs per day.
Zinc
Zinc increases testosterone indirectly by supporting the health of the testicles, where the majority of testosterone is produced in men. A typical dosage for those wishing to supplement is between 5 to 10mg per day. Those with a serious deficiency can range between 25-45 mg per day. Beware that zinc on an empty stomach will cause nausea!
BCCAs
BCAAs (branched chain amino acids) suppress the breakdown of testosterone and have been shown to increase levels of this hormone, sometimes significantly. The exact mechanism for the increase is not yet understood.
Panax Ginseng (Red, Korean or Panax)
Ginseng has been shown to increase testosterone and enhance libido. It also promotes nitric oxide production, which can improve circulation and may be useful for those suffering from ED.
3. Maintain a Healthy Weight
Good news! With increased exercise and a healthy diet, a healthy weight is bound to follow. So, master habits 1 and 2 and you’re pretty much locked in on number 3. Studies have shown that men with a higher percentage of body fat have lower testosterone levels. Similarly, when testosterone levels rise (such as with hormone therapy) weight decreases.
So, raise your testosterone levels and your weight will most likely decrease. Decrease your weight and your testosterone levels will most likely rise. Either way, healthy body weight is essential to healthy testosterone levels.
4. Look at Your Medications
Some prescription medications can lower your testosterone levels. Some reduce androgen production and some block androgen receptors, thereby limiting your body’s ability to make use of the androgens produced. These are referred to as anti-androgenic.
Some antiandrogenic prescription drugs include5:
- Ketoconazole (such as Extina, Nizoral, Ketoderm)
- Cimetidine (such as Tagamet)
- Spironolactone (Aldactone)
- Opioids (such as morphine, codeine, hydrocodone/Vicodin, oxycodone/OxyContin/Percocet)
- Statins (such as Zocor)
Talk to your doctor or pharmacist about your current prescriptions to determine if they are contributing to the issues you’re having.
Hormone Therapy
If lifestyle change alone doesn’t produce relief, then adding hormone therapy may be necessary. Hormone therapy works by taking hormone medications which increase your levels to a point where your symptoms are eased. Therapeutic hormone replacement is often recommended for men who have a testosterone deficiency, or hypogonadism. Studies have concluded it to be a safe treatment option, however, it can have possible risks and side-effects.
Hormone therapy options include:
- Injections (testosterone cypionate, testosterone enthanate)
- Patches (Androderm®)
- Topical gels (AndroGel®)
- Injectable pellets (Testopel®)
Therapy is available as a retail medication (such as brands listed above) or can be custom compounded into different delivery forms or dosage levels. You will need to work with your doctor to determine which is right for you.
What about DHT?
Although outside of the scope of this article, you may have heard about something called dihydrotestosterone (DHT). DHT is derived from testosterone and, although only about one-tenth of testosterone is converted to DHT, it accounts for most of testosterone’s biological action. DHT is, therefore, a huge driver of the functions associated with testosterone. Because your DHT level is a byproduct of your testosterone level, testosterone is targeted for treatment instead of DHT directly.
Treatment Risks
Treating aging-related low testosterone is not a one-size-fits-all solution and safety with long-term use is unclear. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, the benefits aren’t clear and there are possible risks. Among the risks, testosterone therapy can raise a man’s risk for blood clots and stroke and possibly contribute to sleep apnea, acne, and breast tenderness.
A complication of administering the therapy is the lack of established “normal” testosterone levels for men in varying age groups. Just like with women, hormone therapy should be closely monitored by your doctor to deliver the smallest dosage needed to relieve your symptoms.
For further clinical information on the topic, visit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472881/.
Next Steps
As you can imagine, the treatment protocol can be complicated. If you develop symptoms that bother you, it’s important to speak with your primary care physician or men’s health specialist (such as urology, endocrinology, or a functional medicine practitioner experienced in men’s health). Together, you can determine the cause of your concern and work to find the right solution.
For tips on talking to your doctor, visit https://www.everydayhealth.com/hs/low-testosterone-guide/talk-to-doctor-about-low-testosterone/
References
- Horstman AM, Dillon EL, Urban RJ, Sheffield-Moore M. The Role of Androgens and Estrogens on Healthy Aging and Longevity. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2012;67(11):1140-1152. doi:10.1093/gerona/gls068. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636678/
- Endurance training and testosterone levels. PubMed. https://www.ncbi.nlm.nih.gov/pubmed/2675257
- Testosterone and endurance exercise: development of the “exercise-hypogonadal male condition”. https://www.ncbi.nlm.nih.gov/pubmed/16268050
- Fats and Testosterone: Everything You Need to Know About Dietary Fatty-Acids. Anobolic Men. https://www.anabolicmen.com/fats-and-testosterone/
- Can prescription medications affect testosterone levels? International Society for Sexual Medicine. http://www.issm.info/sexual-health-qa/can-prescription-medications-affect-testosterone-levels/.
About the Author
Coastal Pharmacy & Wellness Staff
