What Are the Symptoms of Male Menopause?

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Medically reviewed by Kashif J. Piracha, MD

When people assigned male at birth age, they experience a natural decline in testosterone (androgen) which regulates their sex characteristics. This drop in testosterone is sometimes referred to as male menopause, hypogonadism, or andropause.

Usually this condition occurs around age 40 or 50—about the same time as female menopause—and affects approximately 4 million or more people in the U.S. There has been some controversy, though, about the diagnosis and treatment of andropause, especially since there is little agreement on how to accurately diagnose the condition and treat it. Here is what scientists currently know about male menopause, its symptoms, its causes, and its treatments.

Male Menopause Symptoms

When someone has male menopause, they most often experience a low libido and erectile dysfunction. In fact, one study found that 12% experience low libido and 16% experience erectile dysfunction. Other common symptoms can include:

• Decreased muscle mass and strength
• Increased body fat
• Decreased bone mineral density
• Increased risk for osteoporosis
• Decreased vitality
• Depressed mood
• Concentration issues or short-term memory problems
• Reduced hair growth or hair loss
• Irritability
• Decreased volume of ejaculate

What Causes Male Menopause?

Andropause, or male menopause, is caused by a deficiency in sex hormones due to aging and primarily includes a decline in testosterone levels and dihydrotestosterone (DHT) levels. DHT is a hormone and androgen that plays a pivotal role in the sexual development of people assigned male at birth.

While experts indicate that male menopause can occur at any age, the probability of it occurring at age 50 is approximately 20% and about 50% at the age of 60. Consequently, getting older is one of the biggest risk factors.

There also is chance that male menopause may be caused by other medical issues or conditions that lead to the low testosterone levels. For instance, hypothalamic-pituitary disease should be considered when your testosterone serum levels are low. Other potential causes for low testosterone include trauma, chemotherapy, radiation therapy, vascular insufficiency, or Klinefelter’s syndrome (a genetic condition).

Even chronic illnesses like liver or kidney disease, diabetes, thyroid dysfunction, heart disease, and anemia can cause low testosterone. Mood disorders like depression or anxiety as well as relationship issues and stress can sometimes contribute to symptoms of male menopause.

How Do Testosterone Levels Change?

A gradual, age-associated decline in testosterone levels begins in the mid-30s. In fact, researchers suggest this change typically continues at an average rate of 1.6% per year. That said, there is no well-defined, universally-accepted threshold of testosterone levels.

About 20% of men older than 60 in the U.S. experience low testosterone levels. This number increases to 30% in those older than 70, and 50% in those older than 80 years. But the diagnosis of testosterone issues is controversial.

For this reason, the U.S. Food and Drug Administration (FDA) requires pharmaceutical companies to label all testosterone medications with a statement that their products are approved for use only in persons with low testosterone levels due to known causes.

How Is Male Menopause Diagnosed?

Although there is some disagreement among medical professionals on how to diagnose male menopause, it typically involves evaluating symptoms and testing testosterone levels. For instance, male menopause typically involves a testosterone deficiency accompanied by sexual symptoms such as a loss of libido, lack of morning penile erection, and erectile dysfunction.

Most healthcare providers will conduct lab work to help them make a diagnosis. Some potential tests they may use include:

• Total testosterone level: Because your testosterone levels fluctuate throughout the day, this test is typically conducted at two different times on samples taken before noon. Keep in mind your testosterone levels are lower later in the day. Being sick also can impact your levels, so make sure you let your healthcare provider know if you have been ill before getting this test.
• Luteinizing hormone (LH): LH is a hormone that controls how you make testosterone. Having abnormal levels could mean that you have a pituitary gland problem.
• Blood prolactin level: If you have a high prolactin level, this also could be a sign of pituitary problems or tumors. If your level comes back high on this test, your healthcare provider may recheck the levels again due to the risk of errors with this test.
• Blood hemoglobin or Hgb: Healthcare providers order this test is they suspect an underlying cause like sleep apnea, smoking, or even high altitudes. Make sure you are upfront with your healthcare provider about your smoking habits and sleeping issues.

Sometimes healthcare providers also will use questionnaires alongside a physical exam and blood tests to make a final diagnosis. These questionnaires include Ageing Males’ Symptoms (AMS) scale and the Androgen Deficiency in Ageing Males (ADAM) scale.

The AMS assesses 17 parameters of male well-being divided into psychological, somatic, and sexual groups. Meanwhile, the ADAM looks for a definite dominance of the sexual symptoms to make a final diagnosis.

Treatments for Male Menopause

Most of the time, andropause or male menopause is treated with testosterone replacement therapy. This type of treatment can address issues with libido, memory, muscle mass, and bone strength. If your healthcare provider recommends testosterone therapy, there are a number of ways in which this treatment can be administered. These include:

• Transdermal application: These patches, gels, creams, or liquids are applied to dry skin with an air- or water-tight dressing (unless you are using a patch). Each application lasts about four days and is not removed until the next dose is needed. The risks of this type of treatment include rash or redness at the application site.
• Injections: If your healthcare provider recommends injections, these come in short-term and long-term forms. The short-term medicine can be given under the skin or in the muscle while the long-term injection is usually given in the muscle. These injections may occur weekly, every two weeks, or monthly. With injections, there is a risk of a serious allergic reaction. If you get an injection, your healthcare provider may watch you to make sure you’re not allergic to the medication.
• Oral (or buccal) medications: Known as a buccal dose, this medication comes in a patch that you place above your eyetooth or canine. Even though it looks like a tablet, you should not chew or swallow it. Instead, the drug is released over 12 hours. You may experience headaches with this method as well as irritation where it is placed but it is less taxing on your liver than swallowing it.
• Intranasal medications: This approach involves pumping the medication into your nose three times a day. With this type of application, you may experience some irritation.
• Pellets: If your healthcare provider recommends pellets, these will be placed under the skin of your upper hip or buttocks. You will be given local anesthesia to numb your skin before a small incision is made and the pellets are placed inside your fatty tissues. This medication then releases over about three to six months, depending on the number of pellets your healthcare provider uses.

In addition to the ones mentioned above, there are some other potential side effects to testosterone treatment that you need to be aware of. For instance, there is increased risk of erythrocytosis or an abnormal increase in your blood hemoglobin and hematocrit levels. Additionally, testosterone treatment can interfere with sperm production. If you plan to have children, your healthcare provider may also suggest including treatment for sperm production.

You also need to avoid spreading or transferring your testosterone creams, gels, or liquids to other people in your household. People assigned female at birth and children can experience harmful side effects if they come in contact with these medications.

Make sure you cover the area and wash your hands well after using the medication and do not let the site with the topical medication touch others. Meanwhile, the FDA suggests watching for signs and symptoms of early puberty in kids you live with if you use topical testosterone.

Living With Male Menopause

Typically, testosterone replacement therapy is used in combination with recommended lifestyle changes. If you have low testosterone levels, there are some things you can do to boost your body’s production as well as improve your overall health and well-being.

For instance, if you have obesity, your healthcare provider may talk to you about the best ways to get to a healthy weight for your body. These often include making changes to your eating patterns and increasing your exercise. You also should limit your stress and address any sleep issues. Most people need about seven to eight hours of consistent sleep each night.

You also want to ensure you are eating foods with zinc and vitamin D. These nutrients help balance your hormones and help you produce more testosterone. Adult men need about 11 milligrams of zinc per day, which can be found meat, poultry, seafood, shellfish, beans, nuts, and whole grains. Meanwhile, your healthcare provider may suggest that you take at least 600 international units (IUs) of vitamin D per day.

Finally, having low testosterone levels can impact your mental health. It may be helpful to speak with a mental health professional to help you make sense of the thoughts and emotions you are experiencing regarding your condition. Some people may even benefit from couples therapy if having low testosterone has impacted your relationship.

A Quick Review

Male menopause, or andropause, occurs in people assigned male at birth when their testosterone levels are low. Most often, testosterone starts to decline as a person ages but can become extremely low in some people causing erectile dysfunction, low libido, loss of muscle mass, and more. These symptoms may be caused by a drop in testosterone or may be the result of another health condition like a pituitary gland issue, diabetes, cancer, or a trauma to the area. Typically, male menopause is treated with testosterone replacement therapy. If you suspect you have male menopause, it is important to see a healthcare provider for testing.

Read the original article on Health.com.