Male menopause - does it really exist?

Men's Health

Medichecks doctor Andrew Shaw clears the confusion surrounding the ‘man-opause’ in older men.

Andrew Shaw

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As men age, their testosterone levels tend to decline. Starting between 30 and 40 years of age there is a 1-2% decrease in total testosterone levels each year. Decreased testosterone levels or "the andropause" in men, is very different to the menopause in women. The decrease and the development of symptoms occurs a lot more gradually in comparison to the abrupt decline and almost a complete stop of gonadal hormone production in women. In men, it is rare that there is a complete loss of testosterone production as they age. The terms male menopause, “man-opause” and andropause can be misleading and confusing, as many men maintain normal testosterone levels as they get older.  

What are the symptoms of the male menopause?

Although it may seem that a 1-2% decline in testosterone per year is a worrying rate, if a man’s total testosterone is 25 nmol/L at the age of 30, it will still be a healthy 22.6 nmol/L by 40, and a level of 15 nmol/L at 50 will only result in a level of 13.6 nmol/L by the time he hits 60. Nevertheless, as some men age, they develop mood swings, a decrease in sex drive, loss of energy and a change in body shape. ‘Late-onset hypogonadism’ can sometimes be responsible for these symptoms. However, these changes may be caused by other issues unrelated to a hormone imbalance. Because of this, it is important to distinguish between low testosterone and these other factors as the cause of the symptoms. 

At what age does the male menopause start?

Low testosterone, or hypogonadism, can occasionally occur in later life. Those who are obese and those who have type 2 diabetes are at greater risk. Unfortunately, hypogonadism in men can easily be overlooked or ignored because the changes are often associated with ‘getting old’. Indeed, that may be the case, but what is the harm in investigating the possibility of low testosterone levels if there are symptoms that suggest hypogonadism, particularly as there are effective and safe medications to treat low testosterone. 

How important are testosterone levels for the male menopause?

The normal range of total testosterone in men across all ages is around 8 - 29 nmol/L. It is interesting that many men may function very well towards the middle/lower end of the normal range and experience and exhibit no symptoms of low testosterone, while another man may feel very much hypogonadal at the same level of testosterone. Because of this, it is important to correlate symptoms of hypogonadism with results from blood tests. For a man who has no symptoms of hypogonadism there is no great need to investigate as there would be little reason to treat him, and with no symptoms, he is very unlikely to have a very low testosterone. 

How is the male menopause diagnosed?

If a man is experiencing symptoms, then a total testosterone test would be recommended initially. If the results of this test are within the normal range, then it is unlikely to be lack of testosterone that is responsible for his symptoms. However, it would be beneficial to retest his testosterone level again in 3 months for confirmation.  If the result is less than 12nmol/L then repeating the blood test, together with luteinising hormone (LH), follicle stimulating hormone (FSH) and sex hormone binding globulin (SHBG), a few weeks later would be recommended. If total testosterone is less than 5nmol/L then measuring his level of prolactin would be advised.  There are well developed and widely agreed guidelines, for Europe and for the UK, to treat men who have confirmed low testosterone, together with symptoms of hypogonadism, and it is these men who may derive benefit from testosterone replacement therapy. 

What blood tests can help to identify the male menopause?

Our testosterone test is one of our best sellers and, priced only at £29, can be completed from the comfort of your own home. For a more comprehensive picture of your hormone levels, our Hormone Check Male measures the levels of testosterone and other important hormones including DHEA sulphate, a hormone responsible for male characteristics in both men and women and a free androgen index, a ratio to determine circulating available testosterone. If you are experiencing any niggling symptoms, don’t just blame them on your age, order your Medichecks test today!

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