What Is Andropause? (Male Menopause)
Men are by no means immune to the downturn of hormone levels with age. In fact, the most potent force underlying mental and physical energy in men, the testosterone drive, starts to decline in a man’s mid-forties, or even earlier, depending on lifestyle and stress levels. But unlike the ‘roller coaster’ effect in menopausal women, male symptoms come on more gradually — and most men aren’t sure what’s hit them! But “male menopause” is very real, and it has a name: andropause (from the Greek, “andro” for male and “pausis” for stop). The gradual decline of testosterone and DHEA is the key to changes in male health and vitality. While many medical experts acknowledge andropause as an age-related condition, the general public and too many physicians still do not recognize the term or see it as a natural challenge of aging.
In his prime, 95% of male testosterone is made by the testicles in response to signals from the brain. Over the years, the signal gets weaker, and aging testes are less likely to respond. The hormonal downturn typically begins in the late 30s/early 40s, and by his 70s, a man’s testosterone levels may have dropped by one-third to one-half. If levels of the hormone estrogen are too high relative to lowering testosterone levels, more serious health concerns can sometimes emerge, such as increased risk for prostate problems and/or cancer, cardiovascular disease, loss of bone density, a rise in cholesterol and urinary dysfunction. Male bodies need estrogen in smaller amounts, to regulate brain and sexual functions in particular. During andropause, “estrogen dominance” can overtake waning testosterone levels, complicating symptoms and raising the risk of prostate cancer.
The first thing a man usually notices as his hormone levels taper off is a subtle downward shift in strength and energy. He may lose enthusiasm for the things he used to enjoy, the challenge of work, competition, and sexual activity. Fatigue may set in more quickly, especially after exercise. If your youthful energy has faded to a distant memory, chances are hormones are involved! Optimal levels of testosterone and DHEA help provide the virility, stamina, and drive in men. When they decline (typically beginning around age 40), metabolic changes occur that can sap energy and strength. If progesterone and testosterone levels fall low enough to create “estrogen dominance,” restful sleep patterns may begin to suffer. Inadequate sleep obviously contributes to fatigue. Stress, too, may play a role. Chronic stress especially (ongoing stress that lasts three months or more) negatively affects hormone production, contributing to imbalances that derail metabolic processes designed to promote energy and vitality.
Testosterone plays a key role in body composition and fat cell metabolism. When testosterone levels begin to drop, men lose lean muscle mass and add on the pounds, particularly around the abdomen. The change in body composition has more impact than just “a spare tire.” Multiple studies show that men with low testosterone are at increased risk of osteoporosis and fractures. Lower testosterone levels are also associated with a loss of muscle mass and strength. A 2006 report in the Archives of Internal Medicine found that men aged 65 to 99 with lower testosterone levels were more likely to fall, and to fall multiple times more than their counterparts with higher testosterone levels.
While physical changes are obvious, testosterone’s influence on emotional stability and cognition are subtle yet insidious. A 2008 study of approximately four thousand older men in Australia found that those with depression had significantly lower testosterone levels. In addition, several studies have shown that declining testosterone levels adversely affect memory and problem-solving. When questioned about day-to-day life, many men report a loss of enthusiasm for simple joys, including family and hobbies. Others find it difficult to fully concentrate on tasks at work or at home. When combined with decreased libido and/or sexual performance issues, it is not uncommon for men to begin to question their manhood and identity in mid-life. When a man comes into our practice complaining of fatigue, “feeling low,” and a decreased sex drive, we see red flags waving. This man is in andropause and needs restored hormone balance to feel like himself again.
Aging doesn’t have to equate with weight gain, depression, and exhaustion! As symptoms kick in, hormone testing can be used to help detect and correct existing and/or hidden hormone imbalances. Bioidentical hormone therapy offers a safe, effective way to supplement depleted male hormone supplies. Quality nutritional supplements and lifestyle changes that include a hormone-healthy diet, regular exercise, and stress management offer additional support as your body recovers hormonal equilibrium.
Men are becoming more aware of the importance of hormone balance, not only in the media, but in the transformation they see in their spouses or partners who use it. Our practice used to consist almost exclusively of female patients. Now, one in three of our patients is male – many of them recommended by their spouses or partners! Clinical studies have shown that gradually restoring deficient testosterone and DHEA levels with bioidentical hormones can generally reverse many men’s age-related complaints. Furthermore, if a man has excess estrogen levels, treatment should include a bioidentical progesterone in physiologic doses tailored to need. The added progesterone serves to eliminate “estrogen dominance,” thereby decreasing a man’s risk for urinary and prostate problems.