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Male Menopause: Andropause Symptoms

In both men and women the features of aging tend to overlap with what can attributable to the decline in sex hormone production such as chronic fatigue and poor sleep, but in women the decline is rapid enough to observe unique features such as hot flushes as the body readjust to the ebbing levels of estrogen.

While a similar precipitous fall testosterone, the dominant hormone in men is not observed, it is still largely controversial whether or not to dismiss the notion of male menopause (Andropause) or climacteric.

This different pattern in hormone secretion is rooted deeply in biology.

The female ovaries are endowed with a specific number of follicles (Future ovum) and from puberty, some are recruited, though only one is usually released at ovulation.

During the development within the monthly menstrual cycle, the cells that surround them (granulosa cells) which produce the bulk of the Estrogen divide and grow rapidly. After ovulation they are transformed into cells that produce predominantly Progesterone, the second main female hormone and in the absence of fertilization, these cells are programmed to die. By the age of 35 years most the follicles are exhausted from repeated ovulation and naturally the level of Estrogen decline. (See female menopause)

In men, the story is quite different.

The cells that produce testosterone within the testes do not indulge in this self exterminating monthly cycles. Rather they observe a more stable decline in function over a longer period of time.

If there is no precipitous fall in testosterone, can we conclude that declining levels, even if gradual, is harmless or innocuous?

Though not dramatic, men appears to experience a hormone based deterioration in bodily function and an increased risk to medical disorders such as heart disease and bone mineral loss. In men, it is increasingly been noted that the decreased libido, poor erectile function, mood changes, irritability, fatigue and decreased intellectual function can be linked to male menopause. Other changes include; a decrease in lean body mass and muscle strength due to a reduction in muscle mass, skin and hair changes, particularly the development of hair in the ears and nose and a decrease in the calcium content of bone.

If it is gradual, do we need to bother ourselves about Testosterone replacement?

In some individuals, only this therapy will recoup their lost vitality. The anabolic effect of testosterone curbs the negative effect of a deficiency on muscle, adipose tissue and bone, which is bound to improve the quality of life. In fact the American Society of Andrology recommends testosterone replacement therapy for aging men when both clinical symptoms and signs suggestive of androgen deficiency and decreased testosterone levels are present and also indicated older men with markedly decreased testosterone levels regardless of symptoms, but signs of androgen deficiency should be present. But they emphasizes the need for measurement of total testosterone levels to confirm the hypogonadism (poor testicular function), with a value of less than 300 ng/dl indicating low levels.

Testosterone replacement is not without its ills.

At the age, the risk of Prostate malignancy is high and exogenous testosterone may simply offer the metabolic drive for the neoplastic cells. Therefore it is recommended that symptoms related to bladder outlet obstruction such as poor urine stream and incomplete emptying of the bladder at micturition should be sought. Also periodic rectal examination to screen for enlarged prostate is indicated and regular blood assay for Prostate Specific Antigen, a substance that is increased in the blood stream when malignant transformation is in progress.

While it is safer to accept the notion that men also switch off (male menopause or Andropause is real!), though not as exoteric as if women, that may require hormone replacement, lifestyle interventions such as healthy balanced diet, exercise and good rest are eternally crucial.

Suggested reading

1. Wald M, Miner M, Seftel A (2008). Male Menopause: Fact or Fiction? American Journal of Lifestyle Medicine.

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