Andropause Facts - Male Menopause and Low Testosterone Levels
What is Andropause?
the time men are between the ages of 40 and 55, they can experience
a phenomenon similar to the female menopause, called andropause.
Unlike women, men do not have a clear-cut signpost such as the cessation
of menstruation to mark this transition. Both, however, are distinguished
by a drop in hormone levels of Estrogen in the female, testosterone
in the male. The bodily changes occur very gradually in men and
may be accompanied by changes in attitudes and moods, fatigue, a
loss of energy, sex drive and physical agility.
Studies show that this decline in testosterone can
actually put men at risk for other health problems like heart disease
and weak bones. This usually happens at a time in life when many
men begin to question their values, accomplishments and direction.
It's often difficult to realize that the changes occurring are related
to more than just external conditions and is frequently associated
with what is called a "Mid-Life Crises".
A Gradual Hormonal Decline
While menopause generally occurs in women during their mid-forties
to mid-fifties, the same transition in men may be much more gradual
and develop over many decades. Attitude, psychological stress, alcohol,
injuries or surgery, medications, weight gain and frequent infections
can contribute to its onset.
To compound this frustration, none of these transition
changes are predictable, aside from the fact that there will be
a drop in testosterone. Neither is there a way of predicting who
will experience andropausal symptoms of sufficient severity to seek
What Causes Andropause?
Just as in the female it revolves around a change in the production
and relationship of certain hormones. Starting at about age 30,
testosterone levels drop by about 10 percent every decade. At the
same time, another factor in the body called Sex Binding Hormone
Globulin, or SHBG, is increasing. SHBG traps much of the testosterone
that is still circulating and makes it unavailable to exert its
effects in the body's tissues. What's left over does the beneficial
work and is known as "bioavailable" testosterone.
Andropause is associated with low (bioavailable) testosterone
levels. Every man experiences a decline of bioavailable testosterone
but some men's levels dip lower than others. And when this happens
these men can experience andropausal symptoms. It is estimated that
30 percent of men in their 50s will have testosterone levels low
enough to be causing symptoms or putting them at risk.
What Is The Impact of Low Testosterone?
there is less testosterone available, the testosterone target-organ
response decreases, bringing about a variety of unpredictable changes.
Due to the great variability in testosterone levels
among healthy men not all will experience the same changes to the
same extent. Some typical responses to low bioavailable testosterone
- Low sex drive
- Emotional, psychological and behavioral changes
- Decreased muscle mass
- Loss of muscle strength
- Increased upper and central body fat
- Osteoporosis or weak bones and back pain
- Cardiovascular risk
Are There Any Risks Associated With Andropause?
Apart from the impact that andropause may have on your quality of
life; there are other longer-term and silent effects of andropause
that are harder to track: increased cardiovascular risk and osteoporosis.
Andropause & Osteoporosis
In a healthy individual, bone tissue is constantly being broken
down and rebuilt. In an individual with osteoporosis, more bone
tissue is lost than is regenerated. We've all heard of women suffering
from weaker bones, or osteoporosis, after menopause. In men, testosterone
is thought to play a role in helping to maintain this balance. Between
the ages of 40 and 70 years, male bone density falls by up to 15
Unfortunately, with advancing age and declining testosterone
levels, men, like women, seem to demonstrate a similar pattern of
risk for osteoporosis. What's more, approximately one in eight men
over age 50 actually have osteoporosis.
Two important consequences of osteoporosis are often
seen as a slow but progressive rounding of the shoulders as well
as a loss of height and back pain. Particularly devastating seem
to be hip fractures, up to one third of patients never seem to regain
It is now well accepted that women's risk of atherosclerosis (hardening
of the arteries) increases after menopause. Estrogen replacement
therapy seems to reverse this trend.
New evidence suggests that a similar phenomenon occurs
in men as their testosterone levels diminish with age. While research
is not as complete as for women, the clinical findings point to
an association between low-testosterone levels and an increase in
cardiovascular risk factors in men.
In andropausal men, night sweats and palpitations
occur because of an overactive autonomic system in response to falling
testosterone levels. To assess for hypogonadism, which is in part
the clinical basis of the Andropause, the doctor will check for
physical signs in men including hair loss particularly in the armpit
and genitalia. Psychological tests may be carried out to rule out
depression and other mood and cognitive changes.
Psychological Challenges With Andropause
the life of a male there are several psychological issues that he
struggles with, and these challenges are often amplified during
the time of the Andropause:
- His sexuality
- His emotions
- His mind
- His courage
- His productivity
- His personality
- His character
- His boyish behaviors
The sexuality of a youthful man aged between 15 to
30 years when his testosterone was at an all time high, drops to
the ebb during the Andropause. Young men often have testosterone
levels exceeding 1000ng/dl. Compare this with 80 year-old men, whose
average testosterone is 200ng/dl. You might say the sexuality of
a man in the Andropause is down 80%, a seemingly disastrous event.
In the andropausal years the mind becomes less sharp
and nimble. The older male becomes less swift in mental calculations
and his judgment is not as accurate as before. Although once willing
to take risks of all sorts, the andropausal man becomes more conservative
and fears treading in unclear waters. They no longer participate
in roller coasters and bungee jumping, but rather watch these on
TV instead. Most lose courage to take on new ventures and feel it
is a time to retire and to "take it easy". However, fear
and courage take on a different perspective in the andropausal years,
especially in the older age group of the eighties and nineties.
Productivity is at the core of a man's being. He feels
happy when he creates something and is being noticed for it. He
wants to feel contributory to his family and society. All his life
he struggles to be the breadwinner for the family, and to get recognition
at work for his efforts. In the days of early man, hunting and providing
for his family and society was at the hub of function.
Andropause is a time of decline, when he is no longer
as productive as he was before. Often he makes even less money than
when he was younger, and feels threatened by younger more aggressive
males biting into his turf. With the passage of time, various experiences
and the fall in testosterone, quite a different male may emerge
in later years.
The red hot male often converts to a mellow yellow
version, becoming more "feminine" and "domesticated",
and taking on fewer challenges in the outside world, often preferring
the cozy security of family and close friends. He is much less active,
prefers his couch to watch television, and becomes weaker from lack
Deep inside every man is the desire to remain young
and be that little boy that he once was. This may become more marked
after retirement as usually there is more spare time at hand. The
andropausal man may relive his childhood days, often to the amazement
of his partner or spouse! The mischief may be an extramarital affair,
a new red sports car, a sudden passion for toy train sets, riding
a bicycle, which he hadn't done for years, and so on. Sometimes
of these childish acts may even be mistaken for Alzheimer's dementia!
Andropause Treatment Options
treatment may include lifestyle and dietary changes, herbal supplements
or hormone replacement therapy. Men choose different treatments
depending on the severity of their symptoms, their overall health
and the advice of their doctor. What follows is a brief description
of treatment options.
Testosterone replacement therapy is an option that
must be closely monitored by a physician. Blood tests determine
the current testosterone levels and those are compared to "normal"
The physician must then ensure that the patient only
receives enough of the hormone to bring his levels back up to "normal".
Too much testosterone can actually affect the body's
natural ability to produce the hormone on its own. Men selecting
testosterone replacement therapy as an andropause treatment have
reported positive results in as little as three weeks.
Testosterone can be administered in several ways. Oral testosterone
capsules and lozenges are synthetic testosterone and appear to be
the least effective.
Testosterone injections, also synthetic, appear to
be more effective, but may be painful, because the hormone must
be injected directly into a muscle.
Transdermal patches are worn on the skin and many
people find them uncomfortable. A natural testosterone gel which
is applied directly to the skin was approved for use by the FDA
in 2000 and appears to be very effective as an andropause treatment.
Men using the gel report increased energy levels, sex drive, endurance
and overall muscle strength.
Lifestyle changes can alleviate some of the symptoms
associated with andropause. One study of men who had been previously
sedentary and began a regular exercise program reported increased
energy levels, sex drive and an overall sense of well-being.
A good treatment program for andropause will include
regular exercise and a healthy diet that comprised of foods that
can naturally help boost testosterone levels.
Richard A. DiCenso