WTF Is Andropause (and Is It Real)?
Most men assume the nearest they'll get to experiencing hot flashes is leaning too close to a campfire while splashing it with lighter fluid. But much like women face significant hormonal shifts as they age into menopause, many men in their 50s—or even their 40s—will start to notice steady but significant drops in testosterone combined with slowing androgen receptors (more on this later). This can lead to fatigue, weight gain, lower libido and, yes, hot flashes.
Whatever you want to call this life stage—the media prefers catchy slang terms like andropause or manopause, while Tucson, Arizona–based urologist Lawrence Jenkins, M.D., thinks the simpler "testosterone deficiency" does the trick—the symptoms and effects are very real.
The term andropause comes from the decreasing amount of testosterone that the androgen receptors (ARs) receive, which typically occurs as men age, explained Mike Hsieh, M.D., a professor of urology at UC-San Diego and director of the university's Men's Health Center. These receptors, which are located throughout your body, help direct a man's regulatory response to hormones like testosterone. Or, in short: Everyone has a different daily need for testosterone and that amount has to be in balance so the body can function properly. The symptoms of andropause are the byproduct of an imbalance that's driven by AR sensitivity.
Why? "It just happens as you get older," explained Jenkins, who added that the aforementioned symptoms of andropause typically begin to appear as men cross the half-century mark on this planet. (Men in their 20s and 30s may experience an early-onset version of it, but this is much rarer and typically due to an underlying health issue.) Andropause can be officially diagnosed with two consecutive early-morning low-T readings, he said.
Sean Stewart opens up about the changes he experiences as he gets older, most notably reduced energy and sex drive, due to decreased testosterone levels. Watch the full interview here.
While the accepted scale for what's considered "low" is in the 300 to 350 ng/dl range (and normal being anywhere between 400 and 1,000 ng/dl, depending on age and who you ask), the number is more for insurance billing purposes, according to Hsieh, as the science is still inconclusive about how minuscule that figure should be before it raises concern.
That deficiency, Hsieh added, is becoming common in patients with chronic pain, especially those on long-term opioids. Strong painkillers suppress the brain's ability to send the proper signals to the testes to create testosterone. Additionally, HIV patients can also experience a deficiency in testosterone as the virus can prevent testicles from functioning properly.
'Deficient' means something different for everyone
On top of not exactly being able to quantify what's considered low among the general population, what's considered to be "low-T" in one person may not be the same as for the next. "Some people are born with sensitive androgen receptors," Hsieh said, "and some are not."
Hsieh noted that those with more sensitive receptors likely need less testosterone to operate normally, while those with less sensitive receptors likely need more testosterone day-to-day. As the male body starts to produce less testosterone with age, those with less sensitive receptors might feel the daily effects of that lack of sensitivity through fatigue, lower libido, etc.
Treating testosterone deficiency is common sense—to start
Both Jenkins and Hsieh said that improved diet, exercise and lowering stress can help improve testosterone levels, but when those aren't enough, testosterone replacement therapy (TRT) is a potential option. TRT comes in several different applications: a skin gel, pills, a self-injection, intranasal or even concentrated pellets implanted in your upper hip or rear end. Some options are more effective than others and it can cost upwards of $1,000 per month, so you'll want to have an open conversation with your urologist to figure out which is best for you.
(Jenkins also mentioned prescribing the infertility drug clomiphene as another treatment option. The drug is primarily used to help women ovulate, but he said it can assist the creation of testosterone by helping the brain send more testosterone-producing signals to the testes. But as of now, this is an "off-label" treatment, meaning it's not FDA-approved.)
However, simply signing up for TRT won't fix everything related to a deficiency or lead to dramatic weight loss, Hsieh said. It's important to assess your goals before considering TRT. Are you trying to run a marathon after age 60? Or simply trying to keep up with your grandkids? If it's the former, you'll need more than a hormonal boost to get you across the finish line.
"With our anti-aging culture, everyone is using testosterone to fix their problems," Hsieh said. "But if you're looking for major, noticeable improvement, you might not get as much bang for your buck." So if you were hoping to stop Mother Nature's gentle effects as you edge ever closer to your golden years, don't bank on TRT to solve your problems. However you look at it (and whatever you call it), andropause is simply part of the aging process and one that can be embraced gracefully.