What is Male Menopause?

Is there such a thing as male menopause? "Male menopause is a catchy name but it is definitely not a medical diagnosis," Raevti Bole, MD, a urologist at the Cleveland Clinic, says. 

"In popular culture, it's used to refer to the symptoms of decreasing testosterone and general aging in men." However, since the term male menopause may be confusing and misleading, Bole says, "I recommend using testosterone deficiency, to be most accurate."

"On average, testosterone levels in men drop about 1% per year after their 40s," Bole adds. "Even so, most men do not develop a low testosterone. So, while testosterone levels naturally decline with age, not all men drop low enough to be diagnosed with testosterone deficiency (where their testosterone level is causing symptoms and is lower than threshold)."

Bole estimates that between 10 and 30% of older men have low testosterone levels. Be aware that variations in testosterone testing can affect the correct numbers.

Low testosterone levels can cause low energy, decreased concentration, difficulty putting on muscle or losing fat, depression, low sex drive and worsening erections, Bole says. 

"Most of these symptoms have other causes that are also common such as obesity, diabetes, chronic stress, poor sleep and several others," she adds.

Stanton Honig, MD, a urologist at the Feinberg School of Medicine at Northwestern University, reports that because physicians don't screen for low testosterone, diagnosis is based on reported symptoms.

Suppose a man suspects he has low testosterone or is experiencing symptoms. In that case, he should visit his primary care physician for evaluation so the doctor can check for other factors contributing to the signs. 

"For example," Bole explains, "if you have untreated sleep apnea or poorly controlled diabetes, these need to be addressed."

Then, the doctor can check the testosterone level to see whether it's low. If it is, they can refer the patient to a urologist.

"Menopause in women is universally defined as 12 months after a women's last period, and usually occurs around age 51," Bole notes. After that, the ovaries no longer produce estrogen nor release eggs. In contrast, men don't usually stop making sperm at a definite age. 

"While menopause ends a woman's ability to get pregnant naturally, in men, there's no such universal drop in loss of fertility," Bole says.

"Weight gain is associated with testosterone deficiency," Bole says. "Yet, cause and effect are complicated – weight gain can be associated with other conditions like diabetes as well as lifestyle and diet." Nonetheless, men designated as obese are five times more likely to have low testosterone than non-obese men.

According to Honig, if men experience weight gain, it can be challenging to determine which came first – the weight gain causing low testosterone or the low testosterone causing the weight gain.

"If your testosterone is low, it can be harder to gain lean muscle and lose fat even while you are eating right, exercising and controlling your other medical conditions," says Bole. 

"In this case, it would make sense to replace testosterone," she continues. "But, nevertheless, if your testosterone is normal then the weight gain is probably from something else, and increasing your testosterone is unlikely to help you."

"Fat cells contain an enzyme that converts testosterone to estrogen, so losing fat can help boost testosterone levels," Bole says. "But we need more long-term studies to examine this relationship."

There are a few treatment options available. "Testosterone replacement therapy (TRT) for low testosterone can include injections, patches, gels, pellets and newer formulations like oral medication. Be aware that TRT can affect fertility," Bole explains.

Before a prescription is given, a physician should find out if the patient is interested in having children, according to Honing, because "a man who takes testosterone suppresses sperm production and fertility."

Newer TRT formulations, such as oral medication and a nasal gel, must be taken several times a day. "Testosterone injection is generally the most reliable way to get the medication into your body, at least when starting out," says Bole. An injection is also more likely to be covered by health insurance.

Honig and Bole agree that supplements do not help treat low testosterone. "Supplements are not tested by the FDA (Federal Drug Administration), so it's hard to know what's in them," Bole cautions. "A healthy diet and good quality multivitamin are good to have," she adds.

Here's what you can do to manage low testosterone, as recommended by Dr. Raevti Bole:

• See your primary care doctor to control any other medical conditions
• Do cardiovascular exercise a few times each week
• Get enough sleep
• Eat a healthy diet
• If you have a lot of stress in your life, strategies like meditation or seeing a therapist can help