Menopause and Andropause: Differences and a Question of Inevitability
As people age, their bodies go through changes that are normal and to be expected.
For instance, some men entering middle age may notice a spare tire developing around their midsection. Maybe they don't have the same energy they did when they were in their 20s. Another typical change in men is that their testosterone levels slowly decline with age, about 1 percent per year after age 40, according to Mayo Clinic.
Remember, while some decline in testosterone production is normal—call it andropause if you like—you do have some say in how steep that decline is going to be.
Since the age at which these changes take place corresponds roughly to the age of menopause in women, some people have given it headline-grabbing names like "manopause" or the slightly more medical-sounding "andropause."
As we'll see, though, menopause and andropause are two very different things.
What is andropause?
There's a lot of confusion around the term andropause because it's often used interchangeably with other related terms and concepts. Menopause in women refers to one specific condition, where at about age 50, women's bodies stop ovulating (releasing eggs) and their estrogen levels drop precipitously. Andropause, as the word is commonly used, can mean many things.
We've already touched on one meaning of andropause: to describe typical age-related testosterone decline in men. Again, the aforementioned 1 percent per year decline in testosterone production is normal, expected and, for a majority of men, goes unnoticed.
A second way people may use the term andropause is to refer to clinically diagnosed low testosterone, aka late-onset hypogonadism.
This is a very different condition from the normal decline in testosterone production. Not every man who has lower testosterone levels at age 50 than he did at age 20 has "low testosterone." In fact, men are, in general, expected to have lower testosterone at age 50 than at age 20. However, only a tiny percentage meet the clinical definition for low testosterone, or low-T.
To arrive at a clinical diagnosis of low-T, a patient undergoes two early-morning tests that must show total testosterone values of 300 nanograms per deciliter (ng/dL) or lower, along with symptoms or signs of the condition, such as the following:
- Decreased spontaneous erections or erectile dysfunction (ED)
- Infertility
- Reduced libido
- Breast swelling or discomfort (gynecomastia)
- Height loss, low trauma fractures or low bone density
- Flushing, sweats or hot flashes
- Decreased energy
- Depression
- Difficulty concentrating
- Brain fog
Research cited by Cleveland Clinic suggests that only about 2 percent of men can correctly be clinically diagnosed with low levels of testosterone. According to other research, that figure may be as high as 8 percent for men between the ages of 50 and 79.
To lump in all men who experience normal, age-related testosterone decline with those who have clinically diagnosable low-T under the heading "andropause" is both inaccurate and potentially harmful if it leads to over-prescribing testosterone replacement therapy.
"As men get older, we expect a 1 percent annual decrease in their testosterone," said Amy Pearlman, M.D., a men's health specialist and co-founder of Prime Institute in Fort Lauderdale, Florida. "So, 'testosterone deficiency' doesn't just refer to age-related decline. I look more at the overall health of the patient. A healthy 80-year-old can have normal testosterone."
Menopause and andropause: The same thing?
We've already touched on some of the broad differences between women's menopause and andropause in men, but there are some other important factors to amplify.
One is that, with menopause, hormone production plunges in a relatively short time and women stop releasing eggs altogether. Their ovaries stop producing estrogen, and their bodies switch to producing another form of estrogen from the fat cells. These are drastic changes that result in the constellation of symptoms typically associated with menopause, such as the following:
- Irregular periods
- Vaginal dryness or atrophy
- Chills
- Hot flashes
- Night sweats
- Decreased sex drive
- Painful sex
- Fatigue
- Sleep disorders
- Mood changes
- Loss of fullness to the breasts
- Hair loss
- Dry skin
- Weight gain
While not all women will experience all of these symptoms, they all experience menopause once they reach a certain age. This precipitous decline in estrogen production can cause issues with women's bodies, emotions and minds in a way that the slow decline of testosterone production simply doesn't for the vast majority of men.
"Just because someone is getting older, that doesn't mean they're going to have low testosterone," Pearlman said. "And that's very different from women, where the estrogen rapidly decreases with menopause. That's not necessarily the case with men. It's not an inevitable part of aging."
Even if we're using one of the more dubious definitions of andropause and making it synonymous with clinical testosterone deficiency, it still only affects a tiny percentage of the male population. It typically doesn't arrive as quickly as menopause does, either.
If you have normal testosterone levels in your 20s and only lose the typical 1 percent per year at age 40 and beyond, you can expect to have normal testosterone levels throughout your lifetime.
What are the causes of andropause?
Again, it depends on how we define "andropause."
For up to 98 percent of men, the natural decline in testosterone production of around 1 percent per year after age 40 goes largely unnoticed and doesn't cause any major issues.
There are, however, a handful of conditions that may contribute to lower testosterone levels in older men, including the following:
- Poorly controlled type 2 diabetes
- Obesity
- Sleep apnea
- Chronic obstructive pulmonary disease
- Metabolic disorders
- Chronic liver disease
- Hypothyroidism
- Alcohol abuse
- A history of chemotherapy
- Some medications
Conclusions
Remember, while some decline in testosterone production is normal—call it andropause if you like—you do have some say in how steep that decline is going to be. Barring a clinical diagnosis of low-T, you can do a lot to help ensure your body produces the optimal amount of testosterone.
Even making a few simple healthy lifestyle choices can make a big difference, including the following:
- Get 150 minutes per week of aerobic exercise.
- Maintain a healthy body weight.
- Eat a diet rich in whole, natural foods with plenty of fruits, veggies, nuts and lean protein.
- Avoid overdoing it with highly processed foods.
- Quit smoking.
- Reduce your alcohol intake.
- Get seven to eight hours of sleep per night.
"I think that's good news, because it means people have incredible control over their health and their hormones," Pearlman said.
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