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Male Menopause

Male Menopause – Causes, Diagnosis and its Treatment


Whether you call it “male menopause” or “andropause” – both the terms imply that something gets stopped when in fact nothing gets abruptly stopped in a man. In comparison, the menstrual cycle (precisely it is ovulation) gets stopped at some point in a women’s life. So, I think it is better to discuss the real issue of lowering testosterone levels in a man and how it manifests and impacts on his life rather getting into the saga of terminology.

Hormone changes are a natural part of aging. Unlike the more dramatic reproductive hormone plunge that occurs in women during menopause, sex hormone (testosterone) changes in men occur gradually.

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.

Of the total testosterone in the body, only 2-3% is called “free” testosterone and is the most active component. A blood test is the only way to diagnose a low testosterone level. It is important to take the blood test in the morning between 8am and 11am and there is no need to give blood sample in empty stomach.When a man is thoroughly assessed for low testosterone, a specialist doctor would be looking at the levels of total testosterone and more closely at the free component. Some men do have normal levels of total but less active (free) testosterone. On the other hand, some men with low total levels could still have normal free testosterone. This is why some men with low total testosterone don’t have any signs or symptoms.

Variation 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. An average man’s testicle size is around 20ml (based on Caucasian data). Asian men are believed to have smaller testicles.

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 and strength; 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.

Not every sign and symptom can be blindly attributed to low testosterone. When a man presents to a consultant in sexual medicine or an endocrinologist, he has to be screened for other common conditions that can any of the above mentioned symptoms.  Medication side effects, thyroid problems, depression and excessive alcohol use are some of them. There are also conditions, such as obstructive sleep apnoea, that might affect testosterone levels. Once these conditions are identified and treated, testosterone typically will return to a normal level.

There are different schools of thought around the cut-off level to determine whether a man should be started on treatment (i.e replacing testosterone through patches/gel/oral tablets).

Should you think the condition mentioned above applies to you, please consult your doctor. We are fortunate to live in an era in which expert help can be seeked and good treatment options are available. Try not to self-diagnose and obtain medications over the internet.You may risk your life!