Is the male menopause myth or reality? When men reach their late forties to early fifties, some may experience a reduction in libido (sex drive), erectile dysfunction, weight gain, fatigue, depression, and other emotional symptoms which bear some similarities to the female menopause.
However, the female menopause is completely different. In a woman the menopause marks the time when her menstrual periods stop and she is no longer able to become pregnant. Her levels of female hormones - estrogen and progesterone - decline considerably.
The male menopause is much less abrupt. The signs and symptoms emerge more gradually and subtly, and the decrease in male hormone (testosterone) levels is nowhere near as steep as it is for women.
Do doctors use the term "male menopause"? - No. A health care professional may use the term andropause, testosterone deficiency, or late-onset hypogonadism. Hypogonadism refers to a deficiency in male hormones, where levels are too low even for an aging man. The meaning of late-onset hypogonadism is more similar to what lay people and the media refer to when discussing "male menopause".
Some lay people use the colloquial term "man-opause".
The World Health Organization does not recognize the term "andropause", but does recognize "menopause" (in women).
According to the Cleveland Clinic1, health care professionals are currently debating whether males really do go through a well-defined menopause?
Researchers at Northwestern Memorial Hospital estimated that in the USA five million men are affected by male menopause.
Contents of this article:
Signs and symptoms
Research teams, experts and health authorities appear to have different views when identifying the signs and symptoms of male menopause.
According to the National Health Service2, UK, the following are the most common signs and symptoms of male menopause:
- Hot flashes (UK: flushes)
- Moodiness and irritability
- Fat redistribution
- Loss of muscle mass
- Dry skin
- Thin skin
- Hyperhidrosis - excessive sweating
- Reduced concentration span
- Loss of enthusiasm.
A European study led by researchers at The University of Manchester, Imperial College London, and University College London identified the most common symptoms of male menopause, the study was published in NEJM (New England Journal of Medicine):
- Decreased frequency of morning erection
- Erectile dysfunction - impotence, problems in getting or maintaining an erection
- Decreased sex drive.
The same study also identified the following symptoms as (weakly) related to male menopause:
- Inability to walk more than 1 kilometer (0.62 miles)
- Inability to engage in vigorous activity, such as running or lifting heavy objects
- Inability to bend, kneel or stoop
- Loss of energy
The researchers also ruled out the following (not related to male menopause): problems getting up from a chair, anxiety, nervousness, poor concentration, feeling of worthlessness, and changes in sleeping patterns.
What causes the male menopause?
After the age of 30 years a man's testosterone levels start to drop, about 1% each year. Most men in their seventies have at least 40% less testosterone in their system than they did when they were 30.
However, the normal decline of testosterone levels that comes with age is not believed to be the cause of male menopause. If it were, every man would experience it, and this is not the case.
According to the British Association of Urological Surgeon3 (BAUS), who refer to the male menopause as Androgen Deficiency in the Ageing Male (ADAM), "The overall picture associated with ADAM is, therefore, very complex."
Although male menopause occurs in older men whose testosterone levels have declined, it tends to affect older males with heart disease, obesity, hypertension (high blood pressure) and/or type 2 diabetes.
In other words, unlike the female menopause, several factors together contribute to the development of male menopause.
Psychologists suggest the male "midlife crisis", when men are supposed to wonder what they have accomplished so far professionally and personally, can be a cause of depression and might possibly trigger a cascade of factors that lead to symptoms associated with male menopause.
Could low estrogen be linked to male menopause?
Researchers at Massachusetts General Hospital wrote in NEJM that a proportion of testosterone in men is usually converted into estrogen by a type of enzyme (aromatase).
Men with higher testosterone levels therefore have more estrogen, compared to men with low testosterone. Since those with low testosterone also have low estrogen, it is unclear which hormones are driving certain functions.
Professor Joel Finklestein and colleagues set out to determine whether changes that occur in middle-aged and older men are due to low testosterone, estrogen or both hormones.
They randomly selected 300 men into two groups of about 150. In one group the men were given daily doses of testosterone gel at four levels of dosage, or a placebo gel for 16 weeks. In the other group, the participants were given testosterone gel plus an aromatase inhibitor, which stops testosterone from being converted into estrogen.
They found that the participants on testosterone without the aromatase inhibitor showed similar increases in body fat to what one would expect in a male with mild testosterone deficiency.
What surprised the researchers, though, was that some of the symptoms doctors usually attributed to testosterone deficiency were partly or nearly exclusively caused by a drop in estrogen levels.
In the video below, a doctor talks about the study that was published in NEJM.
Diagnosing the male menopause?
The doctor is not going to say "You are going through the male menopause and the treatments for this are...."
Male menopause is a term used by lay people, and represents a set of symptoms (which experts seem unable to agree on) which may be due to low testosterone (and consequently low estrogen), some underlying diseases, mental issues, obesity, and several lifestyle factors.
The doctor will ask the patient about symptoms, lifestyle and check his medical history.
If the doctor suspects there may be signs of depression or anxiety, he or she may recommend that the patient sees a psychologist or psychiatrist.
The patient may be advised to have a thorough check up that may include blood tests and diagnostic tests to check for cardiovascular disease.
Treatment for male menopause depends on what is causing it.
- Depression or anxiety - the patient may benefit from behavioral therapy, antidepressant medications, or both.
- Obesity - the patient will be advised to lose weight, become more physically active and eat a well balanced and healthy diet.
- Heart and cardiovascular disease - the disease will have to be treated.
- Diabetes type 2 - as with heart disease, it will require proper treatment. Patients with good glucose control tend to have fewer problems and complications.
- Low testosterone - the doctor may recommend testosterone therapy. An article published in Drug Therapeutics Bulletin questions whether testosterone therapy is effective in treating male menopause. Testosterone therapy also raises the risk of blockage of the urinary tract and prostate cancer. It may also aggravate ischemic heart disease, epilepsy, and sleep apnea.
Elizabeth Siegel Watkins, at the faculty of History and Social Medicine, University of California, wrote an article published in the journal Social History of Medicine titled "The Medicalization of Male Menopause in America."4.
Watkins explained that male menopause was a much-discussed topic from the late 1930s to mid-1950s. During the following four decades the topic virtually disappeard.
In the late 1990s, popular American newspapers and magazines began discussing the subject more keenly.
Watkins' study described how the male menopause became medicalized. It was not the result of scientific research or a push from eminent clinicians, it was encouraged "instead by a model perpetuated by lay people and medical popularisers."
In an abstract in the same journal, Watkins concluded "This framework, rather than persuasive evidence from the research laboratory or clinic, helped to medicalise male menopause and provided the basis for its eventual pharmaceuticalisation at the end of the twentieth century."