What is Andropause?
Most people know that women go through menopause. Periods stop, reproduction stops, and there are a number of other signs and symptoms caused by low estrogen levels such as hot flashes and mood swings.
But a dirty little secret that most people don’t know is that many men go through their version of the same thing; their own mid-life crisis. It’s called Andropause or MANopause or the Male Menopause. Another name for it is ADAM which stands for Androgen Decline in the Aging Male.
What are the symptoms?
Unlike women, men can still have kids as they age even into their 90s and of course there are no periods to stop. But their testosterone levels decline gradually by about 1% to 1.5% each year after age 35. With andropause, the male hormone testosterone can drop to the low levels they had before puberty, just like estrogen levels drop in females.
Symptoms can be irritability or a loss of energy and concentration. Some medical people aren’t convinced it exists as a separate diagnosis. They believe it is part of other health issues such as obesity or diabetes. But one book on the topic titled Male Menopause written by a psychotherapist named Jed Diamond claims that andropause affects to 25 million American men between ages 40 and 55 and it can impact their hormonal, physical, psychological, interpersonal, social, sexual, and spiritual lives. In Australia, about 1 in 200 men under age 60 and 1 in 10 men over age 60 have low testosterone. That can lead to osteoporosis or thinning of the bones.
If these 12 symptoms sound familiar, ask your doctor about Andropause:
- Less energy or desire for physical activity
- Less mental quickness
- Fragile bones (osteoporosis)
- Less muscle mass
- Less erections or erections less strong
- Increased body fat, especially around the middle
- Swollen breasts
- Night sweats and trouble sleeping
- Depression or lost enthusiasm
- Loss of libido, loss of armpit or genital hair
- Social withdrawal, loss of confidence
Could these symptoms be due to other things?
Many of these symptoms could be due to a number of other things. Some examples are heart or thyroid disease, infections, poor nutrition, drugs or alcohol, depression, stress, and a whole lot more. They key thing is to seek help and a diagnosis if you notice these symptoms.
Since it doesn’t happen to everyone, are there groups of men at higher risk?
Men who are obese, who have diabetes or high blood pressure are at particularly high risk for developing andropause. Unfortunately, this group of men is increasing all the time. Preventing andropause can be a real incentive to exercise and control weight.
14 Other causes of low testosterone:
- Genetic abnormalities like Klinefelter’s syndrome (an extra “X” chromosome)
- Chronic illness
- Cirrhosis of the liver
- Injury or infection to the testicles
- Chronic kidney failure
- Chemotherapy or radiation
- Androgen insensitivity (normal testosterone levels but can’t respond to it)
- Atherosclerosis (hardening of the arteries)
- High blood pressure
- Certain medications
What is premature andropause?
Sometimes andropause occurs in younger men. Often it is due to exposure to toxins or an environmental problem. Men who work in plastics factories, near incinerators, or on farms that use pesticides are at particularly high risk.
What is SHBG?
SHBG stands for Sex Hormone Binding Globulin. It is a protein that attaches or binds to the sex hormones testosterone and estrogen. When either testosterone or estrogen is bound to SHBG, the hormone is inactive and the body can’t react to it. Its function is inhibited. About 99% of sex hormones are bound to SHBG. Only one percent is unbound or “free” and able to function in the body.
Here is where it gets a little tricky. Men who have andropause have a higher level of SHBG so even more than 99% of their testosterone is bound and unable to function. That leaves an even smaller amount of free testosterone available to function. That man would experience a low testosterone level or andropause.
How do I find out if I have low levels of testosterone?
A blood level of testosterone usually makes the diagnosis. It might take more than one since testosterone levels fluctuate throughout the day. Your doctor might ask you to have your test in the morning since levels are highest then, and he or she might test for both the bound and the free forms of testosterone. Other tests might also be done to be sure the low testosterone level isn’t due to some other cause.
I mentioned 14 other causes of low testosterone earlier.
What can I do to help me with my symptoms?
- Find a friend or support group to discuss what you are going through
- Exercise regularly
- Eat a nutritious, low-fat, high-fiber diet
- Reduce your stress – yoga, meditation and tai chi can be very helpful
- Get time to relax and plenty of time to sleep
- Limit alcohol and caffeine
- Quit smoking
- Drink lots of water
- Get adequate sleep
- Talk with your doctor
What is the treatment for andropause?
Most often, the doctor will advise hormone replacement with testosterone. Testosterone comes in many forms:
- Patches worn either on the body or the scrotum (sac that contains the testicles). Body patches are rotated between the arms, back, buttocks or abdomen
- Gels – applied daily to the arms, back, buttocks or abdomen
- Creams – applied daily to the arms, back, buttocks or abdomen
- Intramuscular injection – usually every 2-3 weeks
- A pellet implanted under the skin
- Oral testosterone usually isn’t used because it could affect the liver
All of these methods work, but each has its own side effects, advantages and disadvantages. With injections, testosterone levels vary between higher levels just after the shot to lower levels just before the next shot is due. Injections can also cause red blood cell counts to become abnormally high.
Patches can be irritating to the skin for a large percentage of men, even if the location is rotated with each new one. Gels and creams cause a special problem: they can rub off on another person and transfer the hormone to your partner. If you use a gel, wash your hands after applying it and allow at least an hour for it to be absorbed. This won’t prevent, but it will reduce transfer to another person.
Symptoms usually improve in 7 to 14 days and within 4 to 6 weeks you will likely feel like a new person. If your blood level of testosterone is normal, more testosterone does not help.
Who should not take testosterone?
Testosterone can stimulate the prostate gland. So men with prostate cancer should not take it. Before taking testosterone, all men should have a prostate exam and screening.
It’s rare for men to have breast cancer, but breast cancer is another reason not to take testosterone.
What are the side effects of taking testosterone?
- Decreased size of the testicles
- Acne or oily skin
- Prostate enlargement, possibly urinary symptoms such as decreased stream
- Sleep apnea worsens (a sleep problem with snoring and frequent awakening)
- Breast enlargement
- Mild fluid retention
- Heart disease
- Cholesterol levels change
- Red cell count increases
- Sperm count decreases, which can lead to infertility in younger men
© Machelle M. Seibel, MD. All rights reserved.
Dr. Mache Seibel, Founder of My Menopause Magazine http://bit.ly/MyMenoMag
Professor, University of Massachusetts Medical School