Understanding Andropause Treatment: Hormone Replacement Therapy and More

What are the best andropause (male menopause) treatments?

‘Male menopause’ or ‘mano-pause’ is the more colloquial (although also misleading) term for the andropause, a condition linked to ageing and declining testosterone¹,². It is also known as androgen deficiency of the ageing male (ADAM).³,⁴,⁵ Mounting research suggests it typically affects men in their late 40s to mid 50s and symptoms can include depression, low energy, memory problems, insomnia, loss of sex drive, hair loss, hot flushes, gynaecomastia (development of breast tissue or ‘moobs’)⁶, erectile dysfunction (ED), irritability, weight gain and changes in urination and to the prostate– all of which can significantly impact on quality of life and may potentially last years.⁷

How to treat, and manage, andropause symptoms

Treating andropause often involves a combination of lifestyle adjustments, medication and, in some cases, testosterone replacement therapy (TRT). Before considering medical interventions, however, lifestyle changes can significantly help in managing andropause symptoms. These include:

Regular exercise. A consistent exercise routine can help improve testosterone levels as well as help maintain muscle mass and improve energy (lethargy and declining muscle mass are common andropause symptoms). Running, cycling, High Intensity Interval Training (HIIT) and strength training such as lifting weights or using your own body weight to exercise are all recommended.⁸ Regular exercise can also help reduce stress and improve mood (also symptoms common in andropause).⁹ Read Top 5 exercises for andropause for inspiration.

Diet. A balanced, unprocessed diet (such as a Mediterranean-inspired one) should not only help improve your health generally and manage your weight, but it should also mitigate some andropause symptoms. Eating regular daily amounts of lean protein, plenty of fruit and vegetables, wholegrains and healthy fats all help with testosterone production. Getting enough protein will also help support muscle mass and bone density and should also keep you feeling fuller for longer. Avoiding refined sugars and processed foods should also stabilise blood sugar levels and keep your energy levels more stable.

Keep your weight down. Being overweight or obese is linked to lower testosterone levels so managing your weight through a combination of diet and exercise will help you through your andropause. One study involving 1667 men aged between 40 and 70 shows that a rise in BMI by four to five points is associated with the testosterone levels of someone a decade older.¹⁰ If you are struggling with your weight studies have shown that time-restricted or intermittent fasting can help with both andropause symptoms and improving your gut microbiome.¹¹

Get enough sleep. Sleep not only helps to keep you generally healthy it also helps facilitate normal testosterone production (levels increase as you sleep and decrease the longer you are awake). Research shows men who don’t get the recommended seven to nine hours a night tend to have lower testosterone levels.¹² For information on why sleep is so important during the andropause and tips on how to improve yours read here.

Stress management. When stressed, your body releases cortisol a hormone which can interfere with testosterone production.¹³ Your mid 40s and 50s can be a stressful time and that stress may be exacerbated by the andropause. Managing it through techniques such as physical exercise, mindfulness, yoga, breathing exercise, meditation and/or counselling can all help lower cortisol and help maintain testosterone levels.

Hormone replacement (TRT)

Testosterone replacement therapy (TRT) involves supplementing the body with testosterone to alleviate low levels and reduce symptoms of the andropause. Testosterone replacement comes in a variety of different forms including:
Patches and gels – which are applied to the skin offering a steady supply of testosterone; pellets which are implanted under the skin and release testosterone slowly over several months and injections, which are administered every few weeks to provide a controlled dose.
Which form you choose is up to personal preference but TRT needs regular monitoring by a healthcare professional to get the dose and mode of delivery right for you. As with any medication there are both benefits and drawbacks.

Pros of TRT

Studies show a range of benefits including improved energy, libido and sexual function, increased strength and muscle mass, stronger bones, better sleep, mood, memory, confidence and concentration, body composition and a general upswing in quality of life.¹⁴

Cons of TRT

For most men the side effects are minimal and/or short-lived with some reporting acne, swelling around the chest area and ankles. There is also an increased risk of sleep apnoea (when your breathing stops and starts during sleep)^.15 . The longer term implications include:

Changes to prostate health. Studies show men taking TRT are more likely to suffer with adverse prostate changes¹⁶ but are not at a higher risk of prostate cancer.

Cardiovascular health. The evidence is mixed here with some studies suggesting TRT could increase the risk of cardiovascular problems¹⁷ whilst others suggest it reduces them.18 If there is a history of heart disease in your family discuss the potential risks of taking TRT with your doctor.

Blood clots. TRT is associated with an increased risk of blood clots or venous thromboembolism (VTE) and that risk peaks in the first three months of using it.¹⁹ Why? It is thought that testosterone interferes with the enzymes that break down blood clots, causing them to form more often.

Sperm count.

Most men experience a serious decrease in sperm count after using TRT. When testosterone is being supplemented in the body externally the body acknowledges this excess and shuts down the natural production of it, leading to lower or absent sperm production. It is obviously not recommended if you planning to have children.

Counselling

For those who don’t want to, or can’t take, hormone replacement another treatment option (along with lifestyle modifications) includes counselling. Counselling or a talking therapy like CBT can help you to address the psychological and emotional aspects of andropause, such as depression and anxiety.

References

 Jane Collins

Health & Her Editor

Back Go back to Expert Advice

Back to blog