Andropause, or the so-called male menopause, is marked by a slow and gradual decline in testosterone levels that can lead to a collection of symptoms1 - some of which may change and evolve over time. The term ‘male menopause’ might be a slightly misleading one – given that it is not equivalent to menopause in women but understanding how the symptoms of testosterone decline shift and manifest themselves can be key to managing and improving health, well-being and relationships during this mid-life and later phases of life .
The initial stages of andropause (30)
The early andropause symptoms typically happen in a man’s 40s but can begin as early as late 30s and are generally linked to declining testosterone levels. The first stages of the andropause may not be immediately obvious - not least because levels of testosterone decline very gradually at approximately 1-2% a year after the age of 30 making the onset of andropause subtle2. This is what makes it distinct from the female menopause (where oestrogen levels tend to fluctuate and decrease more dramatically resulting in more pronounced and well-documented menopause symptoms like hot flushes and brain fog) and which is why many experts say that comparing the two is unhelpful and misleading. The point is initial andropause symptoms are not necessarily easy to identify and may be chalked up to other things going on in life (for example, stress, financial worries or drinking too much alcohol). They can, however, include:
- Decreased energy levels. Many men may start feeling more tired than usual without a clear reason why.
- Mood changes: Increased irritability, mild depression and mood swings can be early indicators of the andropause.
- Decreased libido. A drop in sexual desire is often one of the first noticeable signs.
By picking up on the signs early you should be able to do more to help stabilise and maintain healthy testosterone levels as you get older. (see below).
The middle stages of andropause (40s)
As andropause progresses, symptoms can become more pronounced and may include:
- Erectile dysfunction: Difficulties in achieving or maintaining an erection become more common.
- An increase in body fat, particularly around the abdomen, even without significant changes in diet or exercise habits.
- Loss of muscle mass and strength which can affect physical performance and stamina, and generalised aches and pains.
- Sleep disturbances including insomnia or increased sleepiness, often exacerbated by night sweats.
- Noticeable thinning of hair
The later stages of andropause (50s)
In the later stages of andropause, symptoms may stabilise for some men, but worsen in others, especially if left untreated. Typical signs of later stages of andropause include:
- A reduction in bone density leading to a higher risk of fractures and osteoporosis (brittle and fragile bones)3.
- Memory and concentration difficulties: Cognitive changes can become more noticeable.
- Continued sexual health issues - including a further decrease in libido and sexual function.
- Emotional health concerns. Persistent mood swings, irritability, grumpiness, depression, and a decrease in self-confidence can all manifest themselves in later andropause.
- Urination & prostate changes – increase frequency and urgency of urination, inflation and enlargement of the prostate.
- Severe fatigue - Chronic tiredness and significantly reduced energy levels
- Accelerated hair loss, which may result in thinning and bald patches
Management and mitigation of andropause symptoms
Managing andropause symptoms effectively can involve a multi-pronged approach that can include lifestyle modifications, medical interventions, and, in some cases, testosterone replacement therapy (TRT)4 .
- Doing regular exercise - particularly resistance training and weight-bearing activities5 ;
- Eating a healthy balanced diet and including foods that can help naturally boost testosterone levels6 (interestingly, constant yo-yo dieting7 has also been implicated in lower testosterone);
- Finding effective stress management techniques (long term stress resulting high cortisol levels can affect testosterone levels),
- Stopping smoking; cutting down on drinking and getting adequate sleep (one small study found that sleeping only five hours a night was associated with a 10-15% reduction in testosterone levels in healthy young men8) are all helpful in mitigating the effects of testosterone decline and helping to maintain more stable levels.
- Medical treatment should be tailored to the individual, with consideration given to the benefits and potential risks of testosterone replacement therapy9.
Conclusion
Understanding the evolving nature of andropause symptoms and testosterone decline over time is not only helpful for men themselves but also their partners and potentially healthcare providers, helping everyone to address and manage this phase of life effectively. While the experience of andropause can vary widely, being aware of its very existence and finding appropriate strategies for navigating a way through it should help mitigate its impact on quality of life and hopefully improve relationships.
**This information provides a generalized overview and should not replace professional medical advice.
References
- https://pubmed.ncbi.nlm.nih.gov/20554979/
- https://www.healthcentral.com/slideshow/what-happens-to-testosterone-as-you-age
- https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis-in-men
- https://www.kch.nhs.uk/wp-content/uploads/2023/01/pl-934.1-testosterone-replacement-therapy.pdf
- https://www.webmd.com/men/features/exercise-and-testosterone
- https://www.menshealth.com/uk/nutrition/a747704/boost-testosterone-foods/
- https://www.mdpi.com/2072-6643/10/11/1786
- https://jamanetwork.com/journals/jama/fullarticle/1029127
- https://www.health.harvard.edu/mens-health/is-testosterone-therapy-safe-take-a-breath-before-you-take-the-plunge
