Andropause: The Little Known Male Life Change
"A lot of men may be experiencing andropause without even realizing it."
We all know about menopause, but there's also a lesser-known life change that many men experience, known sometimes as male menopause, or andropause. It's not talked about very often, but it comes with its own difficulties. In this first of his two-part series on andropause, Dr. Keller will explain what this condition is, and what symptoms to look out for. Then stay tuned for part two next week, where he'll provide some tips for addressing it!
- 00:48: So, what exactly is male menopause?
- 02:49: The Role of Testosterone
- 04:56: Diagnosing Andropause
- 06:24: Decreased Libido
- 07:12: Erectile Dysfunction
- 08:35: Difficulty Maintaining Muscle Mass
- 09:31: Weight Gain
- 10:48: Mood Changes
- 12:31: Wrap-Up
So, What Exactly is Male Menopause?
Andropause is loosely defined as a collection of symptoms that could include fatigue and a reduced libido, that are associated with declining testosterone. Today, we're going to talk about some of the symptoms that you might want to look for, and some that you want to bring up with your doctor, as well as some andropause statistics. Then, in part two, we’ll talk about things you can do to balance out andropause, slow it down, or even prevent it.
A lot of men may be experiencing andropause without even realizing it. They might visit the doctor complaining of decreased energy and focus, or a sharp decrease in sex drive, difficulty getting or maintaining erections, difficulty maintaining muscle mass, or even some vague psychological symptoms like feelings of depression, decreased vitality and vigor, or less ambition. This slightly vague assortment of symptoms may often be attributed to just regular aging. But as men get older and start to experience these symptoms, it very well could be andropause.
The Role of Testosterone
Andropause occurs due to a reduction in testosterone, the primary male hormone. It is made in the testes in a special cell called the Leydig cell, and it is responsible for many characteristics we generally attribute to maleness. Boys going through puberty get a surge in testosterone, which starts to make changes in the male body, such as increased height, an enlargement of the sex organs, increased muscle mass, body hair growth, a lowering of the voice, and increased growth of cartilage. You might notice changes particularly in the Adam's apple — the reason women don't have an Adam's apple is primarily because their testosterone levels are lower — but it also causes changes in the nose ears, and those cartilage areas that often give men more masculine features.
This testosterone increase starts at puberty, and it also contributes to things like heightened sex drive and aggression, but that's a whole other topic. Testosterone surges during puberty, then peaks at about age 30. After age 30, it starts to decline about 1% per year. At first, you might not notice much of a difference, but over time as that decline happens year after year, testosterone levels can get low enough that andropause symptoms might become more noticeable. It's estimated that about 20% of men in their 60s suffer from andropause and about 50% of men in their 70s suffer from it. So, if you're in that upper age bracket and you're having some of these symptoms then you need to discuss andropause with your doctor.
The good news is, there is a very reliable way to test for andropause simply by taking a blood test and measuring testosterone in the blood. Testosterone is a hormone that fluctuates widely, so it's best to do a testosterone blood test with your doctor in the morning. Testosterone levels tend to be highest in the morning, which is why men often wake up with erections. So that’s the best way to see what your range is.
There are also different ways to check testosterone, you can check the free (testosterone not attached to other molecules) and the bound (testosterone bound to other molecules). You might want to opt to check both, as this gives a more complete picture of not only how high your levels of testosterone are, but how much active testosterone you have coursing through your blood. The normal range for testosterone is about 300 to 1000, depending on the lab. That being said, men on the younger end of the spectrum will have levels closer to 1000 and as they get older those levels will decrease. But you can have these andropause symptoms before your levels of testosterone get down below the 300 range. Some guys have lived with a testosterone level of about 800 their entire lives, and when they get down to 500 or 400, even though it's still in the normal range for that lab, they could very well have symptoms. So let’s go over those symptoms in a little more detail, and why it is that low testosterone could be playing a factor there.
Symptoms of Andropause
The first and most obvious symptoms is libido, or sex drive. So ify ou find that for the first time in your life, you’re not that interested in sex, that could mean that your testosterone level has gotten too low. Testosterone acts on several different areas of the brain: the cerebral cortex where we have thoughts about sex, and also the limbic system (the more rudimentary brain system that basically drives us to procreate). So, this complex action testosterone has on the brain is really what drives the male libido.
The second thing a man might complain about, having an unusually hard time getting or keeping an erection. It may never have been an issue in the past, but as the years have gone on, it may become much more difficult. Getting an erection is a very complex process, but testosterone plays a key role in facilitating certain biologic processes that allow changes in the vascular flow to the penis. It can help open the arteries that bring blood to the penis and constrict the veins that bring blood out, and this process allows the penis to get blood flow into it. But if your testosterone levels are low, that process is more complicated.
It's really important if you are out there suffering from erectile dysfunction (ED), to discuss it with your doctor because testosterone levels being low is not the only thing that can cause that. There are other more serious conditions like high blood pressure, diabetes, and high cholesterol that can be affecting that. If ED is caused by one of those conditions, it can also mean that you're at risk of having more serious conditions like heart attack and stroke. So, if you are suffering from ED please talk about it with your physician.
Difficulty Maintaining Muscle Mass
Another thing that guys might complain about as they get older is trouble keeping muscle mass on. You might be working out as much as you used to, but feeling flabbier, or it may take you much longer to recover from a workout, or you may injure yourself more frequently. That is because testosterone is a key steroid in helping develop and maintain muscle mass. There are receptors in the muscles that are triggered by the testosterone that basically signal healing, repair, and blood flow. As your testosterone levels go down, your muscles are not getting that stimulus from the testosterone, and then the repair process slows down and the blood flow slows down, meaning you get weaker and you can injure yourself more easily.
Weight gain and slower metabolism might be another symptom. If you were able to eat whatever you wanted, but now that you’re in your 50s you can’t anymore, testosterone may be playing a key role in that too. Part of that is because as muscle mass goes down, your basal metabolic rate goes down. Basically, the amount of calories you're burning just by being there go down. Another thing that happens as testosterone goes down is your insulin gets less efficient. Insulin is a hormone that helps manage sugars and fat storage. So if your testosterone goes down and your insulin isn't working as well, you might pump out more insulin to handle your carbohydrate meals and that can lead to more fat storage.
Andropause, or low testosterone levels can also have an effect on other aspects of mood and the brain. So when a man in his 50s, 60s, and 70s he’s feeling very down, even though there’s nothing noticeably wrong in his work or relationships, this could be associated with low testosterone. It could be that you just don't feel as excited about life, you feel depressed, or just a little more restless and less focused.
If you’re experiencing some of these symptoms you might think it’s regular aging. And granted, your brain and body do change as you age. But if your testosterone levels have gone down too much, that can lead to those symptoms and they can be quite devastating for a lot of guys.
So, if you're experiencing some of those things we just talked about — difficulty getting erections, loss of interest in sex, difficulty maintaining muscle mass, sudden weight gain, or increased depression, lack of focus, and decreased motivation — then please have your testosterone levels checked. Talk to your doctor about andropause and then see what you can do about it.
And stay tuned for part 2, when Dr. Keller will offer some solutions to this common issue.