What is andropause (also known as male menopause)?

The term andropause, sometimes referred to as ‘male menopause’ or ‘mano-pause’ is used to describe a collection of signs linked to declining testosterone ^1,2 . It is also known as androgen deficiency of the ageing male (ADAM) and late-onset hypogonadism (LOH)^{3, 4, 5}. Mounting research suggests it typically affects men in their late 40s to mid 50s and signs can include depression, low energy, memory problems, insomnia, loss of sex drive, hair loss, erectile dysfunction, irritability, weight gain , urination and prostate changes – all of which can significantly impact on quality of life and may last years.⁶

Whilst testosterone is generally associated with sex drive and fertility it is a hormone that is responsible for much more than libido and reproduction, significantly, it also fuels a man’s physical and mental energy, helps maintain muscle mass and is key to maintaining motivation, concentration and confidence. Whilst not an illness or disease, this life stage’s impact on daily life can pose severe challenges for many men in terms of both their physical and mental health. Any natural drop in testosterone can also be exacerbated by being overweight, prolonged stress, drinking too much alcohol and taking certain medications (including some antidepressants which ironically may have been prescribed to help cope with the negative effects of andropause).

Why we need to know more about andropause

The concept of the ‘male menopause’ is not without controversy – some experts deny it exists and chalk it up to a ‘mid-life crisis’. Comparisons with female menopause are also seen to be unhelpful and misleading - oestrogen levels in women are known to fluctuate and drop dramatically leading to more clearly defined and ‘classic’ menopause signs whereas there is no similar precipitous drop in testosterone in men. The decline in testosterone is gradual and falls by around 2%-3% of bioavilable testosterone a year from around age 30 onwards⁷ - although this can lead to a deficiency later on in life.

Others argue andropause is currently an underdiagnosed and undertreated condition which can cause great distress and anxiety for many men in mid-life and later life - and that greater awareness into men’s hormonal health and testosterone deficiency is needed and necessary.

There is also emerging research to suggest that testosterone levels are now dropping by around one per cent generation by generation.^{8, 9} In short, men today have less testosterone compared to their grandads - although experts are not entirely sure why - one study shows a substantial drop in male testosterone levels since the 1980s which doesn’t appear to be the result of health or lifestyle changes and it is theorised it could potentially be attributed to environmental causes. Whilst there may be no single cause for this trend it does suggest that Millennials (those born between 1980 and 1995) and Gen Z or so-called Zoomers (anyone born between 1996 and early to mid 200s) are likely to have significantly lower testosterone levels compared to their predecessors. There are also recent reports from therapists saying they are seeing increasingly younger men coming to see them complaining of declining libido and erectile difficulties, problems which have traditionally been more common among older men.¹⁰

Currently millions of men are of andropause age and thought to be navigating their way through this transitional time which can impact on crucial aspects of life including relationships and work. Some men change careers or completely reconsider their professional commitments due to their experiences (like tiredness and inability to concentrate or motivate themselves). Increasingly too male menopause policies are being put in place in some workplaces, including the NHS, to help men cope with ‘androgen-related issues’. ^{11, 12}

Whilst we need more research and rigorous studies into the effects of andropause it is clear that the area of testosterone deficiency deserves serious attention. What we know so far is that each man's experience of andropause is unique and there is no universal approach to managing its effects. Getting professional medical advice is key but there are also many lifestyle changes that can help alleviate issues.

What age does andropause begin?

Andropause typically begins between the ages of 40 and 55 and is influenced by a range of factors such as genetics,^{13, 14} lifestyle, and overall health. Several factors may also affect the timing and experience of andropause, including:

• Family history, including the early or late onset of andropause in relatives, and potentially including living conditions in childhood.¹⁵
• Being a dad – research shows testosterone levels tend to be lower in fathers ¹⁶
• Body composition – being obese can affect hormone production and metabolism and low testosterone levels are frequently seen in obese males. ¹⁷
• Lifestyle habits – smoking, excessive alcohol use, too much caffeine and lack of exercise can accelerate hormonal decline. ¹⁸

How do you know when andropause is happening?

There is often no clear way of knowing. The most obvious sign of a decrease in testosterone levels are the various physical and psychological experiences described below. If lifestyle changes don’t improve or resolve these symptoms you should see a healthcare professional to discuss what is happening and they may suggest testing your testosterone levels.

Signs of andropause

Andropause can lead to a myriad of signs, affecting men both physically and emotionally. The severity and onset of these experiences will vary widely but may include:

• Decreased libido and erectile dysfunction
• Weight gain, particularly around the abdomen
• Reduced muscle mass and feelings of physical weakness
• Joint pain and discomfort
• Sleep disturbances, including insomnia and night sweats
• Mood swings, irritability, and depression
• Cognitive changes, such as difficulty concentrating and memory lapses
• Reduced bone density, increasing the risk of fractures
• Hair thinning and loss
• Needing to urinate more frequently, and more urgently

Managing andropause

Adjusting to, and managing, the signs of andropause can involve a combination of medical treatments such as lifestyle adjustments, and supportive talking therapies such as CBT to help with mental health and emotional issues. Additionally, focusing on a healthy diet, maintaining a healthy weight, taking hormone-supporting supplements, getting regular exercise, using effective stress management techniques, cutting down on alcohol and quitting smoking can all have positive effects on managing and reducing typical andropause symptoms. Testosterone Replacement Therapy (TRT) can also be used to replenish testosterone levels if deemed appropriate by a medical professional.

References

1. https://pubmed.ncbi.nlm.nih.gov/10687961/
2. https://www.webmd.com/men/male-menopause
3. https://www.news-medical.net/health/The-Male-Menopause-Exploring-Andropause.aspx
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509975/
5. https://pubmed.ncbi.nlm.nih.gov/20554979/
6. https://www.baus.org.uk/patients/conditions/7/male_menopause_androgen_deficiency_in_the_ageing_male/
7. https://www.nhs.uk/conditions/male-menopause/#:~:text=This%20is%20not%20true.,cause%20any%20problems%20in%20itself.
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063751/
9. https://www.researchgate.net/publication/233538976_A_Cohort_Effect_on_Serum_Testosterone_Levels_in_Finnish_Men#:~:text=Serum%20testosterone%20level%20decreased%20in,measured%20in%20the%20Finnish%20men.
10. https://edition.cnn.com/2018/09/19/health/male-menopause-sex-kerner/index.html
11. https://www.ucl.ac.uk/news/headlines/2023/oct/male-menopause-debated-nhs-trust-considers-giving-men-time-symptoms
12. https://www.nhsemployers.org/system/files/2021-06/East%20Midland%20Ambulance%20Service%20andropause%20in%20the%20workplace%20guidance.pdf
13. https://academic.oup.com/jes/article/1/6/560/3574887?login=false
14. https://www.sciencedirect.com/science/article/pii/S2666168321000847
15. https://www.nature.com/articles/s41559-018-0567-6
16. https://www.pnas.org/doi/full/10.1073/pnas.1105403108
17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/#:~:text=Low%20testosterone%20levels%20are%20frequently,in%20sex%20hormone%20binding%20globulin.
18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9708857/#:~:text=Moreover%2C%20unhealthy%20habits%2C%20such%20as,levels%20of%20testosterone%20%5B2%5D.