Andropause: when men go through menopause
It's a widely known fact that women go through menopause. But did you know that men go through male menopause, called andropause? Find out what it is, its symptoms, and how men can manage it.
Most people believe that menopause only happens in women. But did you know there’s such a thing as male menopause?
Experts define menopause as a state in which a woman doesn’t get her period for 12 months. This means her ovaries stop functioning, followed by numerous physical and mental changes.
But when a man undergoes male menopause, his testosterone levels begin to drop by 1% each succeeding year after the age of 30 or later. This reduction is barely noticeable in men younger than 60 years old. But by the time they reach their 80s, their testosterone levels have effectively halved. In men, this is called andropause.
Cause of male menopause
Testosterone is a hormone that a man’s testes produces, and does more than fuel a man’s libido. It’s also responsible for the changes that boys experience during puberty. It drives a man’s mental and physical energy, maintains muscle mass, and regulates fight-or-flight response. The hormone also regulates other key evolutionary features like body hair and the timbre of a man’s voice.
Some experts say there’s is no particularly defined period for male menopause. And there are other medical conditions responsible for the decrease in testosterone production, like diabetes. Testicular cancer or surgically removing the testes can also trigger early onset male menopause. And prostate cancer patients undergo anti-testosterone therapy to maintain low testosterone levels.
A decrease in testosterone causes symptoms like fatigue, weakness, depression, and sexual problems.
How are menopause and andropause different?
Compared to menopause, male menopause is a slow process. In menopause, the ovaries completely stop functioning. But in male menopause, the testes continue to produce testosterone; it just does it less efficiently.
It’s worth noting that a healthy man is capable of producing sperm until the age of 80 or later. But the functionality of testes can deteriorate dramatically between 50 and 70 years of age.
Another difference is in reproductive ability. Women in menopause cannot get pregnant again. But men with male menopause are still capable of fathering children even during male menopause. However, fathering children during male menopause can cause complications because of the quality of the sperm. These complications can lead to a heightened risk of disease in children.
What happens during male menopause?
As a man ages, his body makes less testosterone. While testosterone drops, his body makes more of another hormone called sex hormone binding globulin (SHBG). SHBG pulls usable testosterone from the blood, and binds it. The testosterone that’s left is what becomes available for use by the body.
In effect, tissues in the body that need testosterone for stimulation receive less of it. This is what causes the physical and mental changes that a man experiences during male menopause.
One primary care clinic-based health screening of 1,000 men in Singapore between 2007 and 2009 revealed that 26.4% of men suffered from a form of androgen deficiency.
“Andropause is not as well studied as menopause. It’s known that certain men may have lower male hormone levels in their 50s, but no well-established hereditary, social or behavioural factors have been found that may put a person at higher risk of early andropause,” says Dr Kaysar Mamun. Mamun is a Senior Consultant at the Department of Geriatric Medicine, Singapore General Hospital (SGH), and a member of the SingHealth group.
Symptoms of andropause
Male menopause can cause sexual, psychological, and physical problems that get worse as you grow older. Though symptoms can vary from person to person, depending on their medical history and lifestyle. This is evident from a number of different symptoms like:
- Lower levels of energy
- Sleep difficulties (like insomnia)
- Reduced testes size
- Development of breasts
- Hair loss (anywhere on the body)
- Reduced sex drive
- Lower self-confidence
- Poor concentration
- Increased body fat
- Reduced muscle mass
- Decrease in bone density
- Erectile dysfunction (although pills for high blood pressure can cause this, too)
- Irritability and mood swings
- Night sweats
- Memory loss
Though some of these symptoms are worrisome, like swollen tender breasts, decreased testicle size, hair loss, and weaker bones, they’re rare. They usually affect men at the same age as women who undergo menopause. However, we cannot ignore the fact that complications can arise from male menopause, like an increased risk of cardiovascular problems and osteoporosis.
Diagnosing and treating male menopause
To properly diagnose male menopause, doctors can take a sample of a man’s blood for testing.
Unless male menopause is significantly disrupting a man’s life, symptoms can be manageable without treatment. Perhaps one of the biggest obstacles in treating male menopause is simply talking to a doctor and admitting that the symptoms exist. It’s common for men to be intimidated or embarrassed to talk about male menopause.
Perhaps the most common type of treatment for andropause symptoms is having healthy lifestyle choices. The doctor will most probably advise a man to keep a healthy diet, get regular exercise, sleep regularly, and reduce stress.
These lifestyle habits can curtail the symptoms associated with andropause. They may even improve a man’s overall health. However, if a man is experiencing depression because of male menopause, the doctor can prescribe antidepressants and therapy in addition to lifestyle changes.
Another treatment option is hormone replacement therapy, though it’s a controversial method. It’s akin to performance-enhancing steroids, since synthetic testosterone can have harmful side effects.
In andropause cases where a person has prostate cancer, synthetic testosterone can encourage cancer cell growth. So depending on your health status, weigh all pros and cons before considering hormone replacement therapy.
According Dr. Lee Fang Jann, a consultant at the Department of Urology at Singapore General Hospital, there are three testosterone replacement preparations available in Singapore.
1. Testosterone gels
These are easy to use, but caution must be taken. The gel has to applied every morning on the shoulders and upper arms. Bathing and swimming for five hours after application is prohibited to give your body time to absorb the gel.
- Under no circumstances should you let anybody touch the testosterone gel, on your skin or otherwise. There’s a reason why you cannot swim for five hours after application. Skin contact with the gel raises anyone’s testosterone level, whether they be woman or child. This can cause excess hair growth in women and aggression in children.
- The gel is flammable, so stay away from open flames and other sources of extreme heat.
- After each application, thoroughly wash your hands with soap and water. Cover the applied area with clothing.
2. Testosterone pills
These are taken two to three times a day. Continued use of testosterone pills can raise cholesterol levels and the risk of heart and liver problems. This option is usually just for short-term use.
3. Testosterone injections
These are convenient, but can cause pain at the injection site.
“The latest preparations require only one injection every three months. The absorption rate is very constant and there is no need for the patient to do anything in between the injections,” says Dr Lee.
Risks of testosterone supplementation
More studies are required to determine the safety and efficacy of this kind of treatment.
On the whole, testosterone supplementation can cause rashes, itching, or irritation on the application site. And perhaps the most disturbing is that the long-term side effects of such treatments are unknown.
So men with severe illnesses like prostate cancer and enlarged prostate cannot take supplemental testosterone as it merely accelerates prostate tissue growth.
Of course, there are still people who claim that herbal supplements can relieve or even cure symptoms of male menopause. Remember that none of these supplements have been proven safe or effective against andropause.
Male menopause is normal
A decline in testosterone levels as a man gets older is normal. Men can manage symptoms, even without treatment, with improved lifestyle choices. If it’s still causing a dramatic decline in your health, speak to your doctor.
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