What is andropause or “male menopause”?
As men and women age, there is a natural decline in the body’s ability to produce hormones. When this change occurs in women it is referred to as menopause. In men it is called andropause. The condition was first described in medical literature in the 1940’s and the term andropause was first used in a medical article in 1952. In women, menopausal changes occur quickly and the physical symptoms are very noticeable (hormones fluctuate like a roller coaster ride). In men, andropause occurs over a longer period of time (typically 10-15 years) and the changes are gradual and far more subtle – but no less significant.
Male menopause is not a myth. A recent survey found that 70% of the general public believes that men experience a mid-life stage similar to menopause in women. Testosterone is to men what estrogen is to women. Testosterone is the hormone responsible for normal male sexual behavior (virility), and is involved in many metabolic processes such as lipid metabolism, glucose metabolism, and bone and muscle development. 95% of testosterone is produced by the testicles in response to signals from the brain. A small amount is produced in the adrenal glands. A normal adult man produces approximately 4-7 mg of testosterone per day. Every male experiences a drop in “free” (“bioavailable”) testosterone as they get older, and the amount of decline varies from man to man.
Free testosterone is the active form of testosterone in the body. Free testosterone can move throughout the body to perform its designated functions. Starting around age 30, testosterone levels in men begin to drop. By age 50, the brain signal to make more testosterone has weakened significantly and a man’s testosterone level has dropped by about 40% from the peak levels of his younger years. Further aggravating this problem is the body’s production of Sex Hormone Binding Globulin (SHBG), which increases by 1-2% per year after age 40. SHBG is a blood protein that attaches to testosterone. Once testosterone is bound to SHBG it becomes unavailable for use. Protein-bound hormones are not fully biologically active. Only unbound (free) testosterone is active in the body. Another contributing factor to the onset of andropause is the increased production of aromatase.
Aromatase is an enzyme found in the body that converts testosterone into estradiol (a potent natural estrogen). As men age, their bodies produce larger amounts of aromatase, which causes a shift in the ratio of testosterone to estrogen. In younger men the ratio of testosterone to estrogen approximates 50:1. In older men the ratio drops to 20:1 or even as low as 8:1. As estrogen levels in a man increase, the effects of testosterone are cancelled and estrogenic effects, such as enlargement of the breasts, weight gain, and prostate problems can develop. Men are always taught to rise above their afflictions and not show any signs of weakness. The fact that andropause comes on so gradually, coupled with men’s stubbornness and pride, doesn’t allow them to openly talk with doctors, family, and friends about the changes they are experiencing. Andropause is a health problem that responds rapidly to treatment. It has gained international acceptance as a medical condition, and physicians are becoming increasingly aware of the effective treatment options available.
- Decreased and energy (fatigue, tiredness), and reduced strength and stamina in both work and play.
- Increase in body fat, especially around the midsection.
- Decreased mental acuity and concentration, impaired decision making abilities, and forgetfulness.
- Development of osteoporosis – estimated that 1 in 8 men over the age of 50 have osteoporosis – characterized by a rounding of the shoulders and a loss of height. Osteoporosis puts men at an increased risk of fractures. Wrists, hips, spine, and ribs are commonly involved.
- Decrease in sex drive, sex desire, strength of orgasm, and erectile function. Is your only desirable bedroom activity “getting a good night’s sleep?”
- Loss of competitiveness. Increased passivity & lassitude.
- Decreased eagerness/enthusiasm/enjoyment of life.
- Loss of self-esteem, increased anxiety, nervousness, and development of depression.
- Decreased physical agility and athleticism.
- More sad, angry, and/or grumpy than usual.
- Deterioration in your work performance.
- Low testosterone has been associated with an increased risk of cancer, heart disease, diabetes, and immune disorders.
- Breast tissue development (gynecomastia) – caused by higher estrogen levels and lower testosterone levels.
Take the Andropause Quiz using the list above, put a check next to the symptoms you are experiencing.
How many boxes did you check? If you checked symptom #5, or if you checked more than a couple of boxes, you should consider making an appointment with your prescriber. It is certainly possible that other health problems could be causing some of your symptoms and it is important that you have a thorough medical evaluation to identify them. However, if you are in generally good health and haven’t had a lot of medical problems in your life, your symptoms could be simply from low free testosterone. Encourage your prescriber to order a test of your free-testosterone level — see what the results show.
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