By now, most of us are familiar with the menopause and the misery it causes for so many women.
A successful awareness campaign by celebrities and doctors in recent years has shone a light on the life stage more than 1 million US women around age 50 hit every year when their estrogen levels plummet and their reproductive years end.
But now doctors want to draw attention to a ‘silent epidemic’ that affects men with extremely low testosterone levels — the male menopause.
Like with women, the term is used to describe the period in an adult man’s life when his hormone levels crash, causing a host of symptoms that shatter sufferers’ confidence or are outright debilitating — including erectile dysfunction, depression, anxiety and rapid fat gain.
Like with women, the male menopause is used to describe the period in an adult man’s life when his hormone levels crash, causing a host of symptoms that can be life-changing and debilitating — from erectile dysfunction to depression, anxiety and rapid fat gain
Testosterone levels peak in young adulthood, around age 20, but decline by about 1 percent annually after age 30
Male menopause, which doctors admit is a bit of a misnomer, is medically known as the andropause. Unlike menopause experienced by women, andropause is marked by a more gradual change.
Dr Bob Berookhim, a urologist in New York City and the Director of Male Fertility and Microsurgery at Lenox Hill Hospital, told DailyMail.com: ‘In men, declining testosterone levels tend to occur more slowly and can present at any age, and most men are less likely to present with a sudden onset of low testosterone symptoms.
‘I think the name hurts the chances for men to come in for care. The term may be considered emasculating to some, and these symptoms are often and uncomfortable for men to talk about at baseline.
‘That being said, when patients do come in and I’ve diagnosed them I call it “Manopause” to get a smile out of them!’
Male babies are born with testosterone. Their ‘T’ levels quickly increase during puberty, which causes boys to develop deeper voices, bigger muscles, as well as body and facial hair. The hormone also helps the testes produce sperm crucial for reproduction.
Testosterone levels typically peak at around the age of 20 followed by a slow descent throughout the rest of adulthood. At their highest, testosterone levels should be anywhere between 300 and 1,200 ng/dL. Once men hit their mid-thirties, testosterone levels begin declining by at least one percent per year.
TRT has gotten high praise from podcaster Joe Rogan, who regularly talks about its benefits on air
Jeff Bezos is rumored to have undergone testosterone replacement therapy in order to achieve his new buff physique
Actor Dax Shepherd, 46, is also a proponent of TRT, crediting it for helping him gain 24lbs of muscle
Urologists consider testosterone levels to be too low when they sink below 300 nanograms per deciliter (ng/dL). This happens most often in men in their 40s and 50s.
Estimates from the University of Wisconsin show that low testosterone affects roughly 12 percent of men in their 50s, 19 percent in their 60s, 28 percent in their 70s, and 49 percent in their 80s
Testosterone in males is produced in the testicles and drives sexual development. It regulates sex drive, bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm.
It also acts on the brain and spinal cord as an important regulator of neurological functions. Low testosterone levels are associated with depression and anxiety.
Low testosterone could indicate a problem in the pituitary gland, a pea sized gland located at the base of the brain that monitors and regulates myriad bodily functions through the hormones that it produces.
The age-related hormone changes in men are gradual and while they don’t render male reproductive organs inoperable, the change could cause sexual complications.
Unlike in women, the hormonal change does not render men infertile. Although testosterone is a hormone that drives male fertility, people with low testosterone levels can still produce healthy sperm, though sperm count and quality typically decline.
And while a woman’s transition happens somewhat drastically – within a couple of years – men experience falling testosterone annually from around the age of 40 through their senior years.
Dr Kevin Campbell, a urologist at the University of Florida told DailyMail.com: ‘There’s not a set plateau that all of a sudden guys fall off of.
‘Over time what happens is our bodies will have some insult where they stopped making the same amount of testosterone.
What is ‘male menopause’
The term ‘male menopause’ has been used to describe the period in an adult man’s life when his testosterone levels dip.
Actually, ‘menopause’ is a misnomer, doctors say.
Menopause is generally understood to be a dramatic change in hormonal production which tends to occur over a relatively short period of time.
Deficient levels of testosterone can cause low sex drive, erectile dysfunction, unexplained reduction in muscle mass or sudden gain of body fat, body hair loss, osteoporosis, and depression.
In men, declining testosterone levels tend to occur more slowly and can present at any age, and most men are less likely to present with a sudden onset of low testosterone symptoms.
Testosterone in males is produced in the testicles and drives sexual development.
The hormone regulates sex drive, bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm.
Low T in men is very common. In fact, around 40 percent of men over 45 years old and 50 percent of men in their 80s are affected.
Men with low T may opt to start hormone replacement therapy to combat symptoms and replenish hormone levels.
Testosterone replacement therapy comes in many forms, from topical gels to intramuscular injections.
‘Over time our bodies will start to become less optimized and we start making less testosterone or we use it less effectively. And so that can lead to a constellation of symptoms that has colloquially been deemed male menopause.’
Doctors will typically run a barrage of blood tests on patients presenting with these symptoms to determine what is causing the deficit in testosterone and how to treat it. For instance, low testosterone has been linked to an increased risk of cardiovascular and fatty liver disease.
Dr Boback said: ‘The blood test is absolutely key to diagnosis. It is important to note that this blood testing must be done within three hours of waking up, as testosterone peaks in men at around that time. A late evening test will show an artificially low level.’
Comprehensive blood testing is the gold standard for determining the cause of low testosterone if men begin noticing any symptoms. But many men either neglect to report their symptoms or won’t experience any symptoms at all.
Dr Campbell said: ‘Some people will have family histories or they have someone close to them who’s being treated for testosterone deficiency and so then it makes more sense to them [to get tested], they’re a little bit more aware of the condition to come in and get screened for it.’
Men with low testosterone may opt to start hormone replacement therapy to combat symptoms. Testosterone replacement therapy comes in many forms, from topical gels to intramuscular injections.
TRT helps restore the levels of this hormone in the blood, reversing the symptoms of low testosterone.
Doctors also want men to know that working out is known to increase flagging testosterone levels. Resistance exercises such as lifting weights have been proven by research to help increase short- and long-term T levels.
Some foods, such as magnesium-rich dark leafy greens, eggs, and fatty fish, can also boost T levels. Meanwhile, research has shown that ultra-processed foods and foods that are not dense in nutrients can erode testosterone levels.
Dr Boback said: ‘I generally consider testosterone replacement therapy in men with testosterone level below 300 ng/dL and the presence of symptoms. Generally speaking, there isn’t clear evidence that a simple lab result requires treatment if patients have no symptoms.
‘The decision of how to treat, whether topical gels or injectables or otherwise depends on a number of different factors. Men should know that actual testosterone replacement is highly likely to significantly lower sperm count, in many instances to zero.’
Many men who start testosterone replacement therapy will see good outcomes. A 2019 study reported that therapy can improve libido and treat symptoms of sexual dysfunction. Additional research in 2019 found that TRT can help maintain bone density while previous research in 2016 said it helped improve cognitive function and attention span.
TRT has gotten high praise from podcaster Joe Rogan, who regularly talks about its benefits on air. Amazon mogul Jeff Bezos is also rumored to owe his new buff physique to TRT. And 46-year-old actor Dax Shepherd disclosed on his podcast Armchair Expert that he’s gained 24 pounds of muscle during quarantine using ‘heavy testosterone injections’.