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While menopause is a well-known and widely discussed aspect of female aging, its male counterpart, andropause, often flies under the radar.
Andropause, sometimes referred to as “male menopause” or the male “biological clock,” is a natural, age-related decline in testosterone production and male fertility. Unlike the relatively sudden onset of menopause in women, andropause is a gradual process that can span several decades.
In this blog, we’ll explain this phenomenon and its important place in the realm of men’s health, relationships, and overall quality of life as you age.
Andropause typically begins to manifest in men between the ages of 40 and 60, though some may experience symptoms earlier or later. The Baltimore Longitudinal Study on Aging found that testosterone levels decline by about 1.4% annually after the age of 30. By age 60, approximately 20% of men have low testosterone levels, increasing to 30% by age 70 and 50% by age 80.
However, the onset and progression of andropause can vary widely among individuals. Factors influencing this process include overall health, lifestyle choices, genetics, and the presence of other medical conditions. Notably, men with chronic health issues such as diabetes, hypertension, obesity, or prostate disease are more likely to experience androgen deficiency.
During andropause, several hormonal changes occur:
The symptoms of andropause can be subtle and easily attributed to normal aging. However, recognizing these signs is crucial for early intervention and management. Common symptoms include the following.
Physical Symptoms
Sexual Symptoms:
Cognitive and Emotional Symptoms:
Other Symptoms:
Andropause is a complex journey influenced by biological, psychological, and lifestyle factors. While hormonal changes are central, a man’s mental state and daily habits significantly shape his experience.
Many men face emotional challenges during andropause, grappling with feelings of anxiety or depression as they adjust to changes in their bodies and capabilities. Seeking support from a mental health professional can be invaluable in navigating these complex emotions.
Lifestyle choices play a crucial role in managing andropause symptoms. Regular exercise, particularly strength training, helps combat muscle loss and decreased bone density. A nutrient-rich diet supports hormonal balance, while stress-reduction techniques like meditation or yoga can improve mood and sleep quality.
Moreover, be sure you’re getting enough sleep! Quality sleep is essential for hormone regulation and overall health.
Other natural approaches to managing andropause include maintaining a healthy weight, limiting alcohol consumption, quitting smoking, and staying socially active. These strategies can alleviate physical discomforts, support hormonal balance, and provide emotional support.
What does this mean for you? Should you have low testosterone, it may be a marker of poor health and other medical problems. Over time, this could make it more likely to develop additional medical issues as you age.
From a fertility standpoint, testosterone is a key hormone that plays a role in sperm production, decreased libido and thus frequency of intercourse, and impaired erectile function, are all factors that may lead to decreased fecundity as well.
These facts are obscured somewhat by myths surrounding andropause, including the belief that it’s an inevitable part of aging that can’t be managed.
The reality is that hormonal changes might be natural but severe symptoms can often be addressed through lifestyle changes or medical interventions. Another misconception is that andropause only affects sexual health. Andropause and low testosterone in general can have far-reaching implications for overall health including heart, bone, brain, and reproductive health as you age.
Diagnosing andropause involves both assessing symptoms and measuring hormone levels. A testosterone level below 300 ng/dl, combined with symptoms of testosterone deficiency, typically indicates andropause. However, it’s crucial to have levels checked multiple times, as testosterone can fluctuate.
Depending on your individual situation, management strategies for andropause can vary. Some approaches your healthcare provider might suggest include the following.
Lifestyle Changes
Lifestyle modifications are often the first line of defense in managing andropause symptoms. These changes typically involve improving one’s diet to include nutrient-rich foods that support hormonal balance.
Similarly, your provider may suggest keeping the body moving through increased, regular exercise with a focus on strength training to maintain muscle mass and bone density. Additionally, ensuring adequate, quality sleep is paramount, as it plays a vital role in hormone regulation and overall well-being, helping to mitigate many of the physical and emotional challenges associated with andropause.
Medical Interventions
Medical treatments for andropause primarily focus on addressing testosterone deficiency through various methods. Low testosterone levels can be treated in a variety of methods, such as testosterone pellets, injections, topical gels, or oral medications like clomiphene citrate, enclomiphene, and oral testosterone. Each option has its own benefits and potential side effects, with choices depending on factors like age, fertility concerns, lifestyle, and symptom severity.
Fertility-Preserving Treatments
For men concerned about fertility, the goal of increasing low-t is still the goal but must be done in a different manner to avoid harming reproductive health. Alternative treatments like clomiphene citrate, enclomiphene, human chorionic gonadotropin injections, or anastrozole can boost natural testosterone production without suppressing sperm production.
Above all else, it’s crucial to work with a healthcare provider, preferably one specializing in andropause or men’s health, to determine the most appropriate treatment plan.
While andropause is a natural part of the male aging process, its impact can vary greatly from man to man.
Understanding the signs and symptoms can help you take more proactive steps to manage this transition while maintaining your health.
If you take one thing away from reading this article, it’s this: Andropause doesn’t have to significantly diminish quality of life.
With proper understanding, lifestyle adjustments, and medical support when necessary, you can navigate this phase of life successfully and maintain your vitality and well-being well into your later years.
Assistant Professor of Clinical Urology
USC Institute of Urology
Director, Fertility & Men’s Sexual Health Center
Keck Medicine of USC – Beverly Hills