Male menopause (Andropause)

Menopause in women is well-documented and discussed, but recently, the concept of “male menopause” has come to light. What exactly is male menopause and how does it affect men?

What is male menopause?

Andropause, the medical name given to male menopause is receiving a lot of attention today. Although the WHO does not define andropause, recent research carried out has shown that there are a lot of possibilities to consider. Male menopause is used to describe age related changes in men along with changes in sexual function, mood and energy levels.

What is testosterone?
Testosterone is the male sex hormone (or androgen)and the male version of oestrogen in females. Testosterone decreases naturally by 1% every year after the age of 30 so in the elderly it has decreased as much as 50% from what it was originally. This low testosterone, many believe leads to symptoms of male menopause.
Testosterone is important to maintain various bodily functions like development of male sex organs, maintaining bone strength and muscle mass, carbohydrate and fat metabolism and change in voice and growth of facial hair.
Low testosterone levels are blamed for everything from low muscle mass and bone strength to risk of heart attacks, back pain, loss of libido, and emotional, psychological and behavioural changes.

Should it be called menopause?
Menopause is the term used to describe the cessation of periods in women which is a dramatic stop to her reproductive life. Men experience fewer symptoms and less dramatic ones. Some of the changes are so subtle they may even go unnoticed. Subtle symptoms include depression, irritability, loss of a sense of wellness, fatigue, low energy levels, loss of libido, erectile dysfunction and poor concentration.

Causes of male menopause
Male menopause occurs due to a significant drop in testosterone levels over the years. Other culprits responsible for lowered testosterone levels are diabetes, regular consumption of alcohol and atherosclerosis (hardening of the walls of arteries).

Symptoms of male menopause
Emotional symptoms like depression, lack of enthusiasm for life, lethargy and low self-esteem are noticed. Memory lapses and difficulty concentrating are other symptoms.
Sexual problems like low libido, loss of interest in sex, impotence and erectile dysfunction may occur. The testes may become smaller and infertility may occur.
Physical symptoms like decreased body fat, reduced muscle size and less bone density are almost universal. Some men may develop breasts (gynaecomastia) and lose body hair. Rarely, men may have hot flashes.

Diagnosis of male menopause

If you experience any of the symptoms enumerated above, it is best to see your family physician. A detailed personal and family history will help to differentiate male menopause from other conditions like diabetes, hypertension, increased cholesterol levels and obesity.

Investigation of male menopause
A simple blood test can reveal low testosterone levels. Additionally a complete laboratory profile will help to determine increased cholesterol levels, kidney and liver function etc. Prostatic specific antigen (PSA) may be advised if an enlarged prostate is suspected.

Treatment of male menopause:
A holistic approach is the best method to treat or combat the symptoms of male menopause.

1. Dietary changes like eating low sugar, low fat and high fibre food is important to regulate blood sugar and manage obesity.
2. Physical activity even for half an hour daily improves blood circulation, gives a boost to your brain function and improves mood so there’s no reason to skip that daily walk. As you feel fitter you will want to increase the time and effort spent in physical activity.
3. Lifestyle changes like quitting smoking, minimising alcohol consumption and having a regular sleep schedule are important to avoid mood swings and look and feel your best.
4. If any sexual problems are experienced, it is important to be upfront and discuss it with your physician. If you’re unable to shake the blues, you may need to seek help from a psychiatrist in case you are going into depression.
5. Stress management, yoga and meditation can help you connect with your spiritual side. Couple counselling should be considered if differences with your partner are affecting the quality of your marriage.
6. Drug therapy: Testosterone replacement therapy (TRT)is advised for men having low testosterone with symptoms of male menopause. If there are no symptoms, TRT is withheld.
7. Avoid dubious supplements and herbal preparations as they may contain steroids. DHEA supplements have not been proven to reverse symptoms, instead they may lead to prostate cancer.

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