The Facts About Andropause

Men may not like it much, but as they reach middle age, certain hormonal changes occur that may superficially resemble what women go through during menopause. Hence the name people sometimes give it: andropause.

Testosterone production declines naturally with age, but in some men, it drops so low that it may cause symptoms such as reduced sex drive, erectile dysfunction (ED), fatigue, sleep disruption, bone density loss, depression and more.

Some people even go so far as to call it "male menopause," an eye-catching, headline-grabbing term, but not one that's particularly accurate. Some crucial differences exist between men and women in this regard.

Here, we'll take a look at what andropause means, why it's not exactly a one-to-one comparison to menopause, what causes these changes and how andropause is diagnosed. Plus, we'll discuss some of the symptoms and discuss what, if anything, you can do about it.

When people talk about andropause, they're likely referring to the normal effects on men's bodies once they reach middle age. After about age 30, men's testosterone production drops by about 1 percent per year. Many men don't even notice the change, as it's very gradual.

Andropause can be a confusing term, though, because sometimes it's meant to refer to low testosterone (low-T) in older men, or what's sometimes called late-onset hypogonadism. As these men age, their testosterone levels may drop below normal levels, and they may experience symptoms such as:

• Lower energy
• Lower libido
• Fatigue
• Weight gain
• Loss of muscle bulk
• Sleep disturbances
• Depression

Despite some stand-alone men's health clinics' best efforts to convince people that everyone has low-T, a majority of men of all ages continue to have testosterone levels in the normal range—levels whose 'normal' varies by age.

Some studies suggest that only about 2 percent of men have low levels of testosterone, according to Cleveland Clinic. Other studies suggest that as many as 8 percent of men between the ages of 50 to 79 may have low testosterone.

Knowing the distinction between what is meant by low testosterone and what's usually meant by andropause is important. The expected drop in testosterone with age isn't the same as having clinically diagnosed testosterone deficiency.

Yes, both men and women experience hormonal changes with age, but there are significant differences between the genders in how these changes typically occur. This is a reason many healthcare providers shy away from using the term "andropause."

When women reach menopause, they stop ovulating and their estrogen levels experience a precipitous drop. This dramatic decline is why they feel symptoms such as vaginal dryness, hot flashes, night sweats, emotional turbulence and more. The parallel changes in men are typically so gradual that many men don't even notice them happening.

Men's testosterone levels decline significantly slower compared to what happens with estrogen production in women. If you start with typical testosterone levels as a young man and only lose 1 percent of your testosterone production per year, you can expect to continue having normal levels for your age group for the rest of your life.

Andropause, or the decline in testosterone production as men age, is a natural occurrence. As long as your levels are within normal parameters for your age, it shouldn't cause any problems, and you might not even notice it.

However, there are a number of reasons why a man's testosterone levels might be lower than they ought to be. You have control over some of them. In fact, there are so many potential causes of low-T apart from age that the National Institutes of Health says differentiating between them and teasing out one single cause of any man's low testosterone is a "...unique challenge to clinicians."

Some factors other than age that may contribute to lower testosterone levels include the following:

• Obesity
• Poorly controlled type 2 diabetes
• Sleep apnea
• Alcohol abuse
• Chronic medical conditions such as liver disease or kidney dysfunction
• Certain medications
• Having undergone chemotherapy
• Metabolic disorders

Most men's health specialists will say that some of the best steps you can take to give your testosterone levels a boost are going to sound very familiar: get plenty of exercise, eat a healthy diet, avoid tobacco and alcohol abuse, maintain a healthy body weight and get seven to eight hours of sleep per night.

Low testosterone symptoms vary greatly between individuals, but according to Cleveland Clinic, some of the symptoms that highly suggest low-T include the following:

• Reduced sex drive
• Erectile dysfunction
• Loss of armpit and pubic hair
• Shrinking testicles
• Hot flashes
• Low sperm count

Some other symptoms might include:

• Depression
• Difficulty concentrating
• Increased body fat
• Enlarged breasts
• Decreased muscle mass
• Decreased endurance

Most men will reach middle age and beyond with only a normal reduction in testosterone and, thus, experience no symptoms.

To be diagnosed with low testosterone, a man will need to have blood drawn for testing two separate times. The tests will be ordered to be taken during the morning hours when testosterone levels are highest. If you've recently been ill, tell your healthcare provider, who will probably suggest delaying the test, as illness can cause false low results.

Your blood will be tested for at least four things:

1. Total testosterone. This tells your provider what your testosterone levels are. Normal testosterone levels in men are between 300 and 1,000 nanograms per deciliter (ng/dL), according to American Urological Association (AUA) guidelines. Below 300 ng/dL is considered the cut-off to support recommending testosterone replacement therapy (TRT).
2. Luteinizing hormone (LH). This value can tell your provider if low testosterone is caused by a pituitary gland issue.
3. Follicle stimulating hormone (FSH). FSH is a hormone released by the pituitary gland and responsible for sperm production in adults. High FSH levels may point to a testicular issue, while low levels may indicate the pituitary gland isn't producing enough of the hormone, according to Mount Sinai.
4. Prolactin blood test. High levels of prolactin in your blood can indicate pituitary gland issues or tumors.

To be diagnosed with low testosterone, the patient must not only have low total testosterone values in two separate tests, but he must also have symptoms or signs of low-T, according to AUA guidelines.

In other words, neither symptoms nor low-T numbers alone are sufficient to make a diagnosis.

For most men, the normal reduction in testosterone production will cause no issues as they age.

However, if you are diagnosed with low testosterone, your provider may suggest exogenous testosterone supplementation. They should counsel you on the fact that exogenous testosterone can cause infertility and suggest banking sperm if you might want to have children.

Then they may suggest one or more of the following:

• Testosterone skin gels
• Intramuscular testosterone injections
• Testosterone patches
• Testosterone pellet implants
• Testosterone nasal gel

What are the primary symptoms of andropause?

Three primary symptoms of andropause include reduced sex drive, erectile dysfunction and low sperm count.

What is the age range for andropause?

Andropause, or the beginning of men's natural decline in testosterone production, is usually considered to begin around age 40.

What can cause andropause?

Andropause, if we consider it the typical decline in men's testosterone production that comes with age, is a natural byproduct of getting older. Low testosterone, on the other hand, is a clinically diagnosed condition that may be caused by a number of factors, including age, obesity, poorly controlled type 2 diabetes, alcohol abuse, metabolic disorders, liver disease, kidney disease and sleep apnea.