Andropause: What It Is and How to Treat It
"Male menopause" doesn't always need a fix. Here's how to know if your symptoms are due to changing hormones as you age.
Even if you’ve never heard of the collection of symptoms known as “andropause,” you probably know what it is. That’s because medical marketers use another, more popular term for the condition: “low T” or “low testosterone.” You can’t blame them: low T sounds like a harmless condition with an easy fix.
Andropause is the male equivalent of menopause, the natural decline in reproductive hormones that occurs in women who are, on average, 51 years old. “Male menopause” is often used to describe decreasing testosterone levels related to aging. But age-related hormone changes in women and men are actually quite different.
In women going through menopause, ovulation ends and hormone production plummets over a relatively short period of time, says James Hotaling, MD, associate professor of urology and director of Men’s Health at the University of Utah in Salt Lake City. In men, however, testosterone levels decline gradually over a period of many years. “Their testosterone levels go down about 10 percent a decade,” says Dr. Hotaling. “So it’s going down 1 percent a year which doesn’t seem like that much. But from age 20 to 50, that’s a 30 percent decline.”
This gradual decline of testosterone levels is also called late-onset hypogonadism. And things like obesity, illness, stress levels, and medications can affect the rate of decline.
Is it andropause?
Many guys are totally fine as testosterone begins to dip. Others might notice symptoms, like lack of sexual desire, erectile dysfunction, problems sleeping, losing muscle and gaining fat, depression, or memory problems. There are so many other explanations for the above symptoms that go beyond low testosterone levels, so it’s important to talk with your doctor before assuming you need to be treated.
Your symptoms may be the result of another problem like poor blood circulation, heart troubles, or even digestive issues. Your doctor will give you an exam and a blood test. Male menopause—low T—is a score of below 300 nanograms of testosterone (per deciliter of blood). “It’s important to obtain testosterone levels in the morning because hormone levels peak at 4 a.m. If you check it in the afternoon it’s almost always low,” says Dr. Hotaling. “We usually check it twice because it can vary significantly.”
Only about 2 percent of men have low T, according to the American Urological Association.
So you have andropause
If you have diagnosed low T, as well as some of the symptoms—and they can’t be traced to another condition—then your doc may recommend testosterone therapy to bump up your levels. “We’ll prescribe medication to treat the low testosterone and that could be a number of different forms—gels, creams, injections, or sometimes hormone implants,” says Dr. Hotaling. The results are pretty quick. “Patients usually start feeling better within a week or two.”
Testosterone may not be the right choice
“Pretty much every man you put on testosterone will feel better, but that doesn’t mean every man needs it,” says Dr. Hotaling. “Having a higher testosterone level is associated with a lot of positive changes: more muscle mass, decreased weight, better concentration. What person wouldn’t want to have that? But it’s sometimes inappropriately described.”
It’s also a controversial treatment that comes with real risks, like sleep apnea, acne, breast enlargement, decrease in sperm production, and blood clots. If you have prostate cancer, the treatment can also fuel cancer growth. That’s why it’s not something to take lightly or be looked at as a quick fix.
Alternatives for andropause
Testosterone isn’t the only solution: It’s key that you stay on top of your health. Men are more likely to have low T if they’re overweight or have diabetes. Beyond maintaining a healthy weight, you should also exercise regularly—it’s especially important to focus on strength training to build and maintain muscle—and eat well. If you feel anxious, depressed, stressed, or angry, seeing a therapist can help.
- American College of Obstetricians and Gynecologists: "The Menopause Years"
- James Hotaling, MD, associate professor of urology and director of Men’s Health at University of Utah in Salt Lake City
- American Urological Association: "What is Low Testosterone?"