Male Menopause (Andropause)

As a Behavioral Health Consultant in a health center, I receive calls to assist patients who experience issues around anxiety, depression, substance abuse and other behavioral health concerns.  Today I received a call from a colleague who seemed alarmed when her male patient claimed that he was going through “menopause.” I was pleasantly surprised to hear this because I usually did not hear men talking about male menopause, let alone admitting to it. The fact that my colleague was alarmed by the patient’s claim says something about how it’s a lesser known topic. I was able to have a productive conversation with my colleague about this very real condition in men. 

So then, what is male menopause?  It is more commonly known as Andropause and it is largely related to a decrease in certain androgen hormones in men including testosterone, androstenedione and DHEA (dehydroepiandrosterone), which is a steroid hormone.  Starting at around 40 years of age, some men experience a gradual decrease of testosterone about 1% each year. Not all men have noticeable symptoms during this change and symptoms vary. The difference between menopause in women and andropause in men is that menopausal symptoms are often very apparent and relatively quick, as opposed to andropause symptoms being more gradual and sometimes subtle.  Most men also do not completely lose their ability to reproduce during this time as women do.

According to Healthline.com, “symptoms of andropause may include low energy, depression or sadness, decreased motivation, lowered self-confidence, difficulty concentrating, difficulty sleeping, increased body fat, feelings of physical weakness, development of breasts, decreased bone density, erectile dysfunction, reduced libido and infertility.” Men may find it takes them longer to heal from injuries and gain weight.  They may also lose sight of their direction and purpose in life. Again, not all men notice the effects of andropause. 

There have been a limited number of studies done on the cause and effects of andropause.  Men often are unclear about what is going on with them and sometimes fall into a depressed state believing there is something wrong with them.  They often blame themselves or feel shameful about their physical and mental decline. Some men choose to keep these symptoms silence as they feel they would appear weak or broken.  Men may find themselves going through a "midlife crisis" where they try to compensate or desperately hang on to their youth. This silence and shame contributes to the lack of overall information on this subject.

There are treatment options to balance out the testosterone and other hormones in the body including hormone replacement therapies.  These treatments need to be managed by a doctor and are typically only for men with significantly low testosterone. According to the Food and Drug Administration a normal range of testosterone is typically 300 to 1,000 ng/dL.  So a good candidate would be well below 300 ng/dL. Hormones are administered either intravenously or with a gell. There are no effective pill forms available in the United States at this time and according to the Mayo Clinic, these supplements sold are not very effective and may be dangerous.  If hormone treatment is effective, it may restore some mental and physical capacities. Risk factors for these treatments may include enlarged prostate, some heart issues, blood clotting and other physical implications. This is why this process needs to be monitored closely by a doctor to see if the benefits outweigh the risks.  

There are natural ways to remedy some of the symptoms of andropause and help maintain testosterone levels as well as a healthy prostate.  According to prostate.net it is important to maintain an appropriate diet, a regular exercise routine and engage in stress-reducing activities to promote healthy male hormone levels.  They recommend eating more fruits and vegetables rich in antioxidants, healthy fats and omega 3 foods like avocados, nuts and fish and plant based proteins like quinoa and legumes. It is also important to drink a lot of water.      

In Jed Diamond’s book, “Male Menopause,” he gives another perspective on this phenomenon.  He views andropause as a passage into mature manhood and describes it as “the most passionate, productive and purposeful time of a man’s life...the beginning of the end.”  In addition to defining andropause with historical, medical, and psychological data, he encourages men to recognize andropause as a time of self-reflection, of building a community of men around them and the importance of being the wise elder to young men.  He doesn’t believe this is a time to wallow in loss but to seek opportunity for connection and teaching. 

I’ve noticed in recent years that I had to pay more attention to my weight, my cholesterol levels and overall physical and mental health.  When I was younger I took pride in my ability to maintain a healthy weight and energy without much effort. These days I have to push myself to eat right and exercise to have a normal BMI (Body Mass Index) and I find my vision has gotten worse. I’ve also noticed people in my life getting older or passing on, making death more of a reality.  When I meet with men, including my older brothers, we sometimes talk about and compare our physical ailments and new medications we need to take. I find it very helpful knowing that I’m not alone and that this is a natural process that I’m going through. I want to make sure other men recognize and take effective action in order to minimize the effects of andropause and to live more productive lives.