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Male Menopause

Male Menopause

Intro

Male menopause is characterized by a slow decline in testosterone levels in ageing men. It is sometimes also called andropause or androgen deficiency in ageing male (ADAM). It is not the equivalent of female menopause. While the latter is characterized by a drastic drop in female sex hormones, the former refers to a more gradual decrease in testosterone over time. Moreover not all men experience male menopause. There is also no well-defined male menopause period as testosterone levels in men start to fall gradually from the age of 30 onwards mostly without any outward symptoms and men may continue to produce sperm well into their 80s.

Cause

Circulating hormones produced in the anterior pituitary gland (via stimulation from the hypothalamus), stimulate the testes to produce the androgens – testosterone and dehydroepiandrosterone. In men, testosterone is necessary for sexual drive, muscle and bone mass, fat metabolism, as well as behavior such as aggression and dominance.

Male menopause is caused by a reduction in free or bioavailable testosterone levels. It is unclear what causes this reduction but in some cases it has been associated with a decrease in the interstitial cells of leydig, found in the testes and/or an imbalance in the hypothalamic-pituitary-testicular axis.

Risk Factors:

Studies show that onset is usually seen between 61-70 years. Smokers who smoke more than 10 cigarettes a day are considered to be at an increased risk of early onset andropause.

Clinical Presentation

The signs and symptoms of male menopause usually arise due to loss of testosterone. Since this decline is gradual occurring over years, these symptoms too can be spread over time.

Some men may experience:

  1. Fatigue, tiredness or lack of energy
  2. Problems in sexual function, such as reduced libido, erectile dysfunction and/or infertility. Shrinking of testicles and fewer erections are also seen.
  3. Emotional effects: menopausal men may get depressed, find it harder to concentrate, have short-term memory problems. They may also suffer from mood swings and irritability.
  4. Some men may develop gynaecomastia (the enlargement of male breasts caused by increased growth of breasts tissue)
  5. Muscle mass is lost and men may feel weaker and tired more easily
  6. Changes in hair, skin and fat distribution. For example loss of body hair and the emergence of a pot belly.
  7. Hot flushes
  8. Insomnia or other sleep disturbances
  9. Loss of bone density may make menopausal men more prone to fractures

 

Differential

Some of the symptoms of male menopause can be caused by underlying factors other than low testosterone, these include side effects from medication, thyroid problems, depression and excessive alcohol use. Conditions, such as diabetes, high blood pressure, obstructive sleep apnea and late-onset hypogonadism can also result in low testosterone levels.

Diagnosis

Diagnosis of male menopause involves undergoing a physical exam by a doctor. The doctor will also make note of the symptoms experienced and may prescribe tests such as kidney & liver function tests, blood sugar, cholesterol and thyroid function test to rule out any other medical issues that may be contributing to these clinical manifestations. Blood tests are also done to measure testosterone levels. The normal range in men on average is 270 to 1070 nanograms/dl. It is usually highest in men at the age of 20 and may fall to fifty percent of the normal by the age of 70.

Since, levels of testosterone may fall due to other health conditions (besides aging), it is important to thoroughly test for such conditions.

Treatment

Treatment of male menopause usually involves managing the symptoms. However, it is important to realize that a lot of the symptoms of male menopause are a normal part of aging and it may not be possible to reverse them completely.

Testosterone loss can be treated for using testosterone replacement therapy. This may help reverse certain menopausal symptoms and increase the quality of life. Testosterone is available through intra muscular injections, oral capsules, topical gels and skin patches. Testosterone replacement therapy is accompanied by specific side effects such as increased risk of prostate cancer and men with certain conditions such as heart, kidney or liver disease are usually advised against it.

Besides this, doctors will usually advise a patient going through male menopause to make certain changes and adjustments to their life. These include:

  1. Plenty of regular physical exercise
  2. A healthy balanced diet
  3. Quitting cigarette smoking
  4. Cutting down on alcohol intake
  5. Getting adequate sleep
  6. Managing stress

Menopausal men suffering from depression should also seek psychological therapy and counseling to help them overcome their emotional problems.

Prevention

While testosterone levels fall gradually for all men, there is still a lot of variation in levels between men of all ages and it is not really known exactly why some ageing men experience male menopause and why others do not. It is generally found that men who exercise, follow a balanced diet and avoid stress are more likely to be resistant to male menopause.