Male menopause: Myth or reality?

Hormone changes are a natural part of aging. Unlike the more dramatic reproductive hormone plunge that occurs in women during menopause, however, sex hormone changes in men occur gradually — over a period of many years. Here's what to expect, and what you can do about it.

Debunking the male menopause myth

The term "male menopause" is sometimes used to describe decreasing testosterone levels or a reduction in the bioavailability of testosterone related to aging. Female menopause and so-called male menopause are two different situations, however. In women, ovulation ends and hormone production plummets during a relatively short period of time. In men, hormone production and testosterone bioavailability decline more gradually. The effects — such as changes in sexual function, energy level or mood — tend to be subtle and might go unnoticed for years.

So what's the best way to refer to so-called male menopause? Many doctors use the term "andropause" to describe aging-related hormone changes in men. Other terms for so-called male menopause include testosterone deficiency, androgen deficiency of the aging male and late-onset hypogonadism.

Understanding male hormones over time

Testosterone levels vary greatly among men. In general, however, older men tend to have lower testosterone levels than do younger men. Testosterone levels gradually decline throughout adulthood — about 1 percent a year after age 30 on average. By about age 70, the decrease in a man's testosterone level can be as much as 50 percent.

Recognizing low testosterone levels

Some men have a lower than normal testosterone level without signs or symptoms. For others, low testosterone might cause:

• Changes in sexual function. This might include erectile dysfunction, reduced sexual desire, fewer spontaneous erections — such as during sleep — and infertility. Your testes might become smaller as well.
• Changes in sleep patterns. Sometimes low testosterone causes sleep disturbances, such as insomnia, or increased sleepiness.
• Physical changes. Various physical changes are possible, including increased body fat; reduced muscle bulk, strength and endurance; and decreased bone density. Swollen or tender breasts (gynecomastia) and loss of body hair are possible. Rarely, you might experience hot flashes and have less energy.
• Emotional changes. Low testosterone might contribute to a decrease in motivation or self-confidence. You might feel sad or depressed, or have trouble concentrating or remembering things.

It's important to note that some of these signs and symptoms are a normal part of aging. Others can be caused by various underlying factors, including medication side effects, thyroid problems, depression and excessive alcohol use. A blood test is the only way to diagnose a low testosterone level or a reduction in the bioavailability of testosterone.

Feeling your best

If you suspect that you have a low testosterone level, consult your doctor. He or she can evaluate possible causes for your signs and symptoms and explain treatment options. You can't boost your natural testosterone production, but these steps might help:

• Be honest with your doctor. Work with your doctor to identify and treat any health issues that might be causing or contributing to your signs and symptoms — from medication side effects to erectile dysfunction and other sexual issues.
• Make healthy lifestyle choices. Eat a healthy diet and include physical activity in your daily routine. Healthy lifestyle choices will help you maintain your strength, energy and lean muscle mass. Regular physical activity can even improve your mood and promote better sleep.
• Seek help if you feel down. Depression in men doesn't always mean having the blues. You might have depression if you feel irritable, isolated and withdrawn. Other signs of depression common in men include working excessively, drinking too much alcohol, using illicit drugs or seeking thrills from risky activities.
• Be wary of herbal supplements. Herbal supplements haven't been proved safe and effective for aging-related low testosterone. Some supplements might even be dangerous. Long-term use of DHEA, for example, has no proven benefits and might increase the risk of prostate cancer.

Treating aging-related low testosterone with testosterone replacement therapy is controversial. For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, however — particularly older men — the benefits aren't clear. The risks are a concern as well. Testosterone replacement therapy might increase the risk of prostate cancer or other health problems. If you wonder whether testosterone injections or other testosterone treatments might be right for you, work with your doctor to weigh the pros and cons.

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