Most people are familiar with the female menopause, the time of a woman's life when hormonal changes mark the end of her reproductive years. But men, too, when they reach their late forties to early fifties, may experience changes in their body.
This is sometimes referred to as the male andropause or menopause. But is the male menopause myth or reality?
According to an article by Elizabeth Siegel Watkins, published in the Social History of Medicine, the male menopause was a much-discussed topic from the late 1930s to the mid-1950s, but it virtually disappeared over the next 40 years.
In the late 1990s, popular American media began again brought the male menopause into the spotlight, but there is little evidence to confirm that it the male menopause is a medical condition.
Contents of this article:
What are the signs of change?
There is little evidence to confirm that it the male menopause is a medical condition.
For a woman, the menopause marks the time when menstruation stops, and she is no longer able to become pregnant. Her levels of female hormones, estrogen and progesterone, decline considerably in a relatively short period of time.
In a man, the changes are less abrupt. They emerge slowly and subtly, and the decrease in the levels of male hormone, or testosterone, is less steep than it is for women.
Health professionals do not use the term "male menopause," but they may refer to the phenomenon as andropause, testosterone deficiency, or late-onset hypogonadism. Hypogonadism refers to low levels of male hormones in a man.
When lay people and the media talk about the "male menopause," the symptoms they are referring to sometimes describe the condition of late-onset hypogonadism.
Researchers at Northwestern Memorial Hospital in Chicago, IL, estimate that in the United States, 5 million men are affected by the so-called male menopause.
Signs and symptoms of the change in men
Characteristics of the male menopause have been described in different ways.
The United Kingdom's National Health Service (NHS) lists the signs and symptoms of male menopause as follows:
- Hot flashes
- Moodiness and irritability
- Accumulation of fat around the abdomen and the chest
- Loss of muscle mass
- Dry and thin skin
- Hyperhidrosis, or excessive sweating
- Reduced concentration span
- Decreased energy
- Decreased sex drive.
The normal decline of testosterone levels that comes with age is not believed to be the cause of male menopause.
A study carried out in the U.K. and published in New England Journal of Medicine (NEJM) identifies the most common symptoms of male menopause as a decreased sex drive, including a lower frequency of the morning erection, and erectile dysfunction.
Other symptoms described by the team include a loss of energy, an inability to walk more than 1 kilometer, or 0.62 miles, and difficulty engaging in vigorous activity, such as running or lifting heavy objects. Kneeling, bending and stooping become more difficult.
Sadness and fatigue are also attributed to the change in male hormone levels.
Items that the team did not link to male menopause include 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 gradually. It falls by 1 percent on average, and by less than 2 percent each year.
Most men in their seventies have at least 40 percent less testosterone in their system than they did when they were 30 years old.
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.
The British Association of Urological Surgeons (BAUS), who refer to the male menopause as Androgen Deficiency in the Aging Male (ADAM), describe the situation as "very complex."
This suggests that it is not only a change in the levels of male hormones that contributes to the development of male menopause.
Erectile dysfunction may be the result of changes in the blood vessels or a neurological problem.
Some men undergo a "midlife crisis," in which they become concerned about what they have accomplished so far professionally and personally. This can be a cause of depression, and this may trigger a cascade of factors that lead to symptoms associated with male menopause.
A lack of sleep, poor diet and lack of exercise, smoking and alcohol consumption and low self-esteem may also contribute.
Hypogonadism is a condition in which the testes do not produce enough hormones. In younger males, this can lead to delayed puberty. If it develops at an older age, possibly linked to obesity or type 2 diabetes, "male menopause" symptoms may occur.
Could low estrogen be linked to male menopause?
Research has shown that a proportion of testosterone in men is usually converted into estrogen by an enzyme, known as aromatase.
Men with higher testosterone levels will, therefore, also have more estrogen. It follows that men with low testosterone will also have low estrogen, so it is unclear whether testosterone or estrogen drives certain functions.
One study has suggested that some of the symptoms that doctors usually attributed to testosterone deficiency partly or mostly result from a drop in estrogen levels.
Diagnosis and treatment of the male menopause
One study, "The Medicalization of male menopause in America," describes how the male menopause became medicalized, not as a result of scientific research, but because of "a model perpetuated by lay people and medical popularizers."
The term "male menopause" is unlikely to be used by a physician. It represents a set of symptoms on which there is little agreement. These symptoms may be due to low testosterone, and therefore also low estrogen, some underlying diseases, mental health issues, obesity, and a range of lifestyle factors.
Since the condition has not been clearly defined, men who experience it will receive treatment according to their symptoms.
A patient with obesity will be advised to lose weight, become more physically active and eat a well-balanced and healthy diet.
Diabetes, heart and cardiovascular disease will require appropriate treatment. Controlling blood glucose levels appears to reduce symptoms.
A healthy diet and exercise is often advised, especially in obese patients.
A detailed check-up, including blood tests and diagnostic tests, may be carried out to detect any cardiovascular disease.
A patient with signs of depression or anxiety may be referred to a psychologist or psychiatrist, who can prescribe antidepressants, behavioral therapy or both.
In some cases, the doctor may recommend testosterone therapy, although the effectiveness of this treatment is not confirmed. Testosterone therapy can increase the risk of a blockage in the urinary tract and of prostate cancer. It may also aggravate ischemic heart disease, epilepsy, and sleep apnea.
A range of supplements and vitamins are advertised to treat the male menopause, but the Mayo Clinic warns that herbal remedies have not been proven safe and effective as a treatment for an age-related decline in testosterone levels, and some may even be hazardous.
While lay people and the media discuss male menopause and its implications, there is insufficient evidence to define it as a true medical condition. However, a lifestyle that involves a healthy diet, regular exercise, avoidance of tobacco and limited alcohol is likely to boost a sense of wellbeing.