Everything You Need to Know About Male Menopause, Known as Andropause
Ah, middle-age — the self-doubt, the existential angst, the sudden awareness of just how short life is. Work, marriage, kids. It’s not easy. And then comes the lack of enthusiasm, the tiredness, the brain fog and the irritability. But these are not necessarily de facto products of having made it to a certain age.
Rather they are symptoms — and you can throw in hot flushes, insomnia, mood swings and a general disinterest in sex — of a still controversial idea: that, like women, men experience ‘menopause.’
This is not a definitive biological, hormonal event as it is for women — the sometimes decade-long spell of similar symptoms, leading to a lack of menstruation for a year, followed by officially entering one’s post-child-birthing phase of life. It likely doesn’t have quite the same negative impact on well-being, on relationships and work.
Certainly not everyone in medical circles thinks it’s even a real thing, and scientific study of the ‘manopause’ — more officially, the andropause — is lacking. And yet many men, and increasingly, clinicians too, concede that something sometimes happens when you hit your mid-40s or early 50s. You go off the boil.
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“The male menopause just isn’t as well recognized as the female menopause,” explains Dr. Clive Morrison of London’s Centre for Men’s Health. “This is in part because the latter is a natural, well-documented event for every woman, but it’s a less distinct, drawn-out process for most men, and it doesn’t affect all men either. In part it’s because we’re not really sure why it happens to men. And in part also because of culture, which still broadly has a temperance attitude to sex. The male menopause is confused with the stigma around loss of libido, even though that’s only one possible symptom. But this is more about your mojo. It’s about your quality of life.”
It doesn’t help, of course, that a lot of the many possible symptoms of andropause are products of aging too: like it or not you can start to lose muscle — typically about 3-5 percent of your muscle mass every 10 years after the age of 30. You might put on weight too, or rather your body fat is redistributed, so you get a bit of a belly. This all makes correct diagnosis of the andropause tricky — a situation only made worse because, as Morrison stresses, each of us has our own threshold levels for each symptom, such that a man may display all of the psychological signs and some but by no means all of the physical or bio-chemical ones.
And psychological factors may be indicative of something else — depression, maybe, not the andropause. Inevitably this all makes deciding on the right course of action tricky too.
There are simple things that we know do help — that, in fact, help towards better health generally. Move more — at a minimum just taking good, regular, long walks. Train gently but regularly with weights. Eat a low-carb, high protein diet. Get a good eight hours sleep every night. Address the stress in your life rather than normalizing it.
But others — those who may be tempted to supply a quick fix, much as HRT or Hormone Replacement Therapy has (not uncontroversially) become for menopausal women — also suggest that the andropause is likewise a hormonal issue in men. It’s all, they say, about a loss of testosterone, as for women about estrogen.
Indeed, far from the misconception of testosterone as being all about sex, its decline is also linked to muscle atrophy, reduced bone density and a susceptibility to depression; and there’s an inverse correlation with obesity and mortality from heart failure — the less of it you have, the more prone you are to both issues. This is why some experts dub the male menopause Testosterone Deficiency Syndrome. And why often testosterone replacement therapy is pushed.
Anecdotally, that certainly works for some men. But don’t rush into this. For one, while the rapid shutdown in estrogen production has been attributed to symptoms of the female menopause, men typically see only a 2% testosterone decline per year over their thirties. It’s argued that this is unlikely to have noticeable consequences.
Then there are the practical issues: regular testosterone injections — this is how it’s typically delivered into the bloodstream — don’t come cheap. Prices vary but we’re often talking at least a few hundreds dollars per month — and, obviously, those who recommend this treatment also profit from it too. Nor can you just have these as boosters to get back on track: since injecting testosterone also typically causes your natural testosterone production to gradually close down, once you start, you’re committed for life. It’s a crutch, not a cure.
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This doesn’t help when a drop in testosterone can be hard to measure conclusively — healthy testosterone levels may disguise a decline from even higher ones. Current understanding also has it that subtle shifts in testosterone levels are more part of a broader package of metabolic changes in various key hormone levels — prolactin, gonadotropin, DHEA and others you’ve likely never heard of — with consequences similar to those experienced by menopausal women.
“It’s all very complex,” sighs Morrison. “It’s often partners who first notice the problems — the moodiness, the low libido. But then that gets misinterpreted and the man is sent off for marriage guidance when that kind of intervention isn’t what’s needed at all. It’s the male menopause.
But understanding that, understanding the part played by testosterone — which a lot of general practitioners still think of as some kind of snake oil — is only recent. That’s just over the last 10 to 20 years, which unfortunately is not very long in medicine.”
In other words, we’re still some way from grasping quite what the andropause is, what to do about it and, in some quarters, whether there’s anything to do anything about. All of which is little consolation for those men who are suffering from a nasty potpourri of physical and psychological ailments that — just when careers are peaking, just when they’re maybe wrangling both children and elderly parents, when retirement seems a lifetime away and time to look after themselves is almost zero — comes along and really screws with their day.
But don’t let that put you off. If you’re not feeling right, and something inside leaves you unconvinced if it’s all just the normal pressures of a certain time of life, see a doctor. The ‘manopause’ may sound like a joke, but it doesn’t feel like it.
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