Is there really a male menopause? Learn about aging-related changes in men.
Less interested in sex lately? Tired? Grumpier than usual? Is this a midlife crisis brewing? Or are you feeling the normal hormone changes associated with aging? Hormone changes are a natural part of aging for men. But male menopause is not an accurate description. Unlike the more dramatic hormone plunge that occurs in women during menopause, hormone changes in men occur gradually, over a period of many years, the effects of which are often subtle and not noticed until much later in life. Some men are never affected by lower hormone levels at all — while some have physical and psychological symptoms that can include changes in sexual function, energy levels or mood.
While the term "male menopause" is sometimes used to describe decreasing testosterone levels related to aging, Todd Nippoldt, M.D., an endocrinologist at Mayo Clinic, Rochester, Minn., prefers the term "andropause." "There needs to be a distinction because we're dealing with two different situations," he says. "In women, ovulation ceases and female hormone production plummets over a relatively short time frame. In men, there's a gradual decline in the production of male hormones." Age-related decline in testosterone levels are also called testosterone deficiency, androgen decline in the aging male (ADAM) or late onset hypogonadism (LOH).
Male hormones over time
In general, older men have lower testosterone levels than do younger men. After age 40, testosterone levels in the blood begin to decline gradually — at a rate of about 1 percent a year. While there's a steep drop between the ages of 45 and 50, reduction in testosterone levels are rarely significant enough to be noticeable in men younger than 60. By the time men reach their 80s, about half have low testosterone. But testosterone levels vary greatly among men — and some men maintain normal testosterone levels into old age. Other men who have low testosterone levels don't have bothersome signs or symptoms.
Male hormones over time
In general, older men have lower testosterone levels than do younger men. After age 40, testosterone levels in the blood begin to decline gradually — at a rate of about 1 percent a year. While there's a steep drop between the ages of 45 and 50, reduction in testosterone levels are rarely significant enough to be noticeable in men younger than 60. By the time men reach their 80s, about half have low testosterone. But testosterone levels vary greatly among men — and some men maintain normal testosterone levels into old age. Other men who have low testosterone levels don't have bothersome signs or symptoms.
Testosterone replacement therapy
Treatment of low testosterone due to aging with testosterone replacement therapy (TRT) is controversial. The benefits of TRT are not clear, and it may increase the risk of prostate cancer. While certain men who have symptoms related to abnormally low testosterone may benefit from testosterone replacement therapy, it isn't appropriate treatment for most aging men. While it has been shown to help some men with low testosterone, TRT has risks, especially for men with certain health conditions such as prostate cancer and heart disease — and it may not improve your symptoms. More studies need to be done to determine the effectiveness and safety of TRT in aging men, and who can benefit most from this type of treatment. As it turned out with hormone replacement for women, TRT may have possible long-term risks that are not yet known.
Is it low testosterone — or is it something else?
Symptoms caused by testosterone deficiency are similar to symptoms caused by other things. Signs and symptoms can include:
- A number of other health problems such as liver disease, kidney failure, or an overactive or underactive thyroid
- Side effects of medications
- Lifestyle choices such as excessive alcohol use or use of illegal drugs
- Psychological conditions, such as depression or emotional distress related to life changes that come with middle age (the so-called midlife crisis)
Last Updated: 07/26/2007
