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What is Andropause? Causes, Symptoms and Best Treatment Methods.

Explore the signs, causes, and treatments of andropause, also known as male menopause. Learn how to manage symptoms for improved health and well-being

We are all familiar with the menopause among women, which begins in women ages 45 and 55. Menstruation ceases, and fertility returns as a result of a drop in reproductive hormones like progesterone and estrogen. Hot flashes, night sweats, sleeplessness, impatience, anxiety, sadness, and forgetfulness are some of the physical and mental symptoms that women may have throughout this period.

But have you ever heard of a male menopause? From the late 1930s until the mid-1950s, the idea of male menopause started circulating in medical circles and eventually made its way into the mainstream media. Although it is less commonly acknowledged or understood, menopause, also known as andropause, is a significant life transition for males. This article will discuss andropause and how we can manage it.

What is Andropause?

As men age, their androgen levels, especially testosterone, gradually decrease, a process known as andropause. As the principal male sex hormone, testosterone is essential for the maturation of the testes, prostate, and other male reproductive tissues, as well as secondary sexual traits, including increased bone and muscle mass and hair growth.

Andropause is known by numerous names, including male menopause, male climacteric, androgen deficit in aging males (ADAM), viropause, and partial androgen deficiency in aging males (PADAM).

Testosterone levels declining with age

Is it Male Menopause?

In terms of science, it is inaccurate to refer to andropause as “male menopause” because of the fundamental distinctions in biological processes between men and women. The term menopause refers to the end of the menstrual cycle in women, and males don’t experience that. Calling it andropause is much better.

The normal downturn in testosterone levels 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.

According to the American Urological Association, 2 out of every ten men aged 60 and older have low testosterone levels. Curiously, research has also shown that andropause is far less common in tribal men’s populations compared to Western men’s.

Menopause Vs. Andropause

Men may also go through changes in the body with aging. And it’s essential to look at it through the lens of the biological changes that happen around adulthood. The following differences make it clear that guys do not go through menopause.

  • Gradual vs. Sudden Hormonal Decline: Testosterone levels in males fall gradually, usually around 1% a year, beginning at approximately the age of 40. One study suggests that 90% of men will have andropause symptoms by the time they reach their 80s, with 30% of men experiencing symptoms in their 50s. Any symptoms associated with decreased testosterone levels will not manifest for quite some time due to this gradual reduction. On the other hand, in menopause, estrogen and progesterone levels drop precipitously in women, causing changes to be more noticeable and evident right away.
  • Reproductive Ability: Males often retain fertility even when testosterone levels are decreased. This is because sperm production is regulated by more than just testosterone. Menopause, in contrast, marks the last stage of a woman’s reproductive years, when her ovaries no longer produce eggs.
  • Hormonal Deficiency: The end of menstruation and the ability to procreate is a natural part of every woman’s life cycle and a standard indicator of hormonal deficiency. Some men never experience low testosterone levels beyond what is considered normal.

Screenshot 2024 02 28 021119

Not all men experience andropause.

Causes of Andropause

We now know that andropause is brought on by an aging-related shortage of sex hormones, which is mostly manifested as a reduction in testosterone and dihydrotestosterone (DHT) levels.

The causes of andropause are primarily related to aging. Still, there can be many factors that can aggravate the decrease in testosterone levels, such as being overweight, smoking, drinking too much, being stressed out, and not getting enough exercise.

Testicular cancer and surgical removal of the testes are among the medical diseases that might cause premature andropause. Additional possible reasons for low testosterone include vascular insufficiency, radiation treatment, prostate cancer, chemotherapy, trauma, and Klinefelter’s syndrome, a hereditary disorder.

Symptoms of Andropause

How can a man tell if his testosterone levels are too low? Particularly hot flashes and night sweats, a couple of them might resemble menopausal symptoms. Having said that, this won’t happen to every man who suffers from low testosterone. These symptoms are subject to occur in 1 out of 200 males. The following symptoms characterize testosterone deficiency:

  • Fatigue and general weakness
  • Erectile dysfunction (ED)
  • Difficulty concentrating
  • Weight gain, particularly in the abdominal region
  • Impaired short-term memory and “brain fog
  • Anxiety or irritability
  • Difficulty sleeping (insomnia)
  • Reduced muscle mass
  • Infertility or impotence
  • Low bone density

andropause symptoms

According to research published in the NEJM, the three most prevalent symptoms in males are erectile dysfunction, reduced libido, and a decline in the frequency of morning erections. Another 2015 study stated that 12% of men experienced low libido and 16% had erectile dysfunction.

It is crucial to remember that andropause isn’t always confirmed by the presence of one of these symptoms. If any of the above symptoms occur to you, it is advised that you speak with your healthcare physician. According to American Urological Association (AUA) guidelines, a man is considered to have low testosterone if his level is less than 300 ng/dL.

But in andropause, the production of testosterone does not entirely stop, like in prostate cancer.

Diagnosing Andropause

The official diagnosis of andropause is not yet available, and there is an ongoing controversy about the diagnosis. Still, there are specific tests that can detect changes in the testosterone levels of the body. A new diagnostic recommendation for andropause is to look for the symptoms, a physical exam, and a blood test to determine an average testosterone level are the three main components. A urologist or andrologist recommends these tests.

After reviewing the patient’s medical history, a doctor would likely do a prostate exam to rule out enlargement as the underlying cause of the patient’s symptoms. After a thorough physical examination, a doctor may request blood tests to check hormone levels and look for signs of other reproductive problems. When other medical conditions are ruled out, a diagnosis of low testosterone levels can be made.

A morning testosterone level below 300 nanograms per deciliter (ng/dL) can be registered as a low T count (testosterone count). Because testosterone levels change during the day, it’s important to remember that multiple blood tests could be necessary to get more accurate findings.

According to experts, only in cases where symptoms are present should older men be tested for low testosterone. A second test must validate the results if low testosterone is detected. In males in their 70s, full-blown deficiency affects fewer than 20% of the population and even less in younger men as they age.

How Can We Treat Andropause?

It may be possible to reduce the symptoms of male andropause. But if you are interested in preventing your testosterone levels from falling, you’ll have to make some adjustments to the way you live.

1. Lifestyle Modifications

It is well-known that unhealthy eating habits, a lack of physical activity, excessive alcohol intake, and smoking contribute significantly to both aging and illness, and testosterone level fluctuation is no different from that.
Changing one’s lifestyle, particularly one’s eating habits, level of physical activity, and amount of sleep, is the first step once one has low testosterone.

  • Increasing Physical Activity: Engaging in regular physical activity, such as weight lifting or resistance training, has been found in 2010 research to increase testosterone levels, facilitate muscle growth, and stimulate metabolism.
  • Having a Good Diet: Consuming a well-balanced diet that includes foods rich in zinc, omega-3 fatty acids, vitamin D, and calcium plays a significant role in promoting hormone production.
  • Reduction in Alcohol Consumption: Research indicates that excessive alcohol consumption leads to a direct decline in testosterone levels.
  • Sleep: Obtaining sufficient sleep is critical to preventing andropause, given that testosterone production occurs during rapid eye movement (REM) sleep.

These modifications have been verified, and symptoms seem to subside when these lifestyle factors are controlled.

2. Consulting on Time

Medical health professionals and experts recommend getting the testosterone levels examined if anyone is over 40 and experiencing symptoms like poor energy or diminished sexual drive.

In 2018, researchers from the New England Research Institutes found that adherence to therapy was low among males with low testosterone, at around 5%. The main reason for this low statistic is that a majority of males do not have annual checkups, which results in important health concerns going undiagnosed and untreated. A complete medical examination is essential.

3. Hormonal Replacement Therapy (HRT)

As long as this is not harmful to your health, or one might have extreme symptoms, there is no need to worry. But suppose this change is having a negative impact on their health, well-being, or relationships. In that case, a new treatment method known as testosterone replacement therapy (TRT) is comparable to hormone replacement therapy (HRT) for women whose health is suffering from menopause.

This Testosterone Replacement Therapy (TRT) has been demonstrated to be quite beneficial. If your healthcare physician recommends testosterone therapy, there are several ways to administer this therapy. Such as

Topical Gels

This method of testosterone delivery involves applying gel-based testosterone to the arms, shoulders, or abdomen. The hormone enters the bloodstream after being absorbed through the skin. One care to be taken is washing hands after each application to avoid contact with other skin parts. Special care must be taken if a man under TRT therapy comes into contact with any woman or child; it can develop secondary and unwanted effects on them, such as increased aggressiveness in children and new hair growth in women.

Skin patches

These patches are applied to dry skin using an air- or water-tight dressing on the back, abdomen, upper arms, or thighs. These patches release testosterone transdermally over 24 hours, providing the hormone topically. Each application lasts 2-4 days.

Pills:

Also known as buccal doses. When placed on the gums just above the incisors twice daily, it should not be chewed or swallowed. These would cause the oral tissues to secrete testosterone into the bloodstream. This approach keeps hormone levels stable by avoiding the liver’s metabolism.

Injections 

Intramuscular injections are an alternative to subcutaneous pellets. When given by a trained professional, these hormone injections quickly increase hormone levels in the bloodstream. In as little as one day, you can see a difference. In contrast to gels and creams, injections must only be administered every two months to maintain naturally high hormone levels.

Subcutaneous Hip Pills or Pallets

Hormone pellets are little capsules with crystalline testosterone. They are 3 mm by 9 mm and are placed under the skin around the hip. The process usually involves implanting 10 to 12 pellets via surgical methods.
Following the treatment plan, these pellets will gradually release the appropriate amount of your hormone deficiencies over three to four months to restore hormonal balance.

Due to the convenience and fewer reactions of only needing to visit our clinics every few months, many patients opt for pellets. But before starting to take testosterone pellets, it can be wise to determine your body’s optimal testosterone dosage with other daily testosterone application methods, including creams or patches.

Nasal Sprays 

This approach involves applying testosterone to the nasal mucosa, which allows it to be absorbed directly into the bloodstream. It calls for a maximum of three applications daily.

Here’s a more concise version of all the methods mentioned.

Method Application Frequency Notes
Topical Gels Skin Daily Wash hands after use.
Skin Patches Skin Every 2-4 days Use air-/water-tight dressing.
Pills Gums above incisors Twice daily Do not chew/swallow.
Injections Intramuscular Every two months Quick hormone increase.
Pellets Under skin (hip) Every 3-4 months Gradual hormone release.
Nasal Sprays Nasal mucosa Up to 3x daily Direct bloodstream absorption.

Personal preferences, medical history, and way of life should all be considered when selecting the most appropriate method of TRT; this should be discussed with a healthcare professional.

These testosterone therapy treatments are having outstanding results for many men around the world. It may take some time for the treatment to take effect. Still, once it does, patients typically report significant improvement in energy levels, regained energy, and sexual life, in addition to dramatically reducing symptoms. Hot flashes, mood swings, impatience, and weak erections are some of the physical symptoms that are characteristic of menopause, and TRT therapy may often significantly alleviate these symptoms.

Both men with and without low testosterone levels can significantly benefit from the treatment, which boosts arousal and overall sex satisfaction. However, it is advisable to consult a medical professional before starting any treatment.

Testosterone replacement therapy, while considered safe, may not be suitable for everyone, especially men with a history of prostate cancer. However, it is to be kept in mind that this therapy doesn’t cause cancer; it can increase the growth of cancerous cells.

Conclusion

Men may also feel the effects of aging on their bodies due to naturally dropping testosterone levels, but menopause is an entirely female-specific biological phenomenon. But that doesn’t mean that the decline in testosterone must not be addressed in aging men. A proper diagnosis and treatment must be carried out. While not universal, certain males may experience sufficiently tolerable symptoms without medical intervention. If, however, your symptoms are proving to be problematic, you should seek medical attention.

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Dr Aimen

Being a Doctor by profession, Aimen is passionate about helping people get better health in their lives. Aimen enjoys her research on Prime With Time subjects and strives to create better awareness of the problems and changes related to women's health.

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