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When our hormones become our enemies:Male menopause

Updated: Jun 26, 2020


We are excited to start our new posts series: "When our hormones become our enemies".


June is male health awareness month. Therefore, we decided to start the series by shedding some light on a condition that hasn't received the attention it deserves in the media- male menopause. Yes, yes, it very much exists and thousands of men suffer from the symptoms of untreated male menopause due to the lack of awareness about this condition.


Today we will tell you everything you need to know about male menopause.


Name


Let’s start with the name. The name “Male Menopause” isn't really appropriate for this condition. The word menopause implies a sudden drop in sex hormones concentration in the blood, which is observed in women during perimenopause. In men, however, the decrease in testosterone levels is not as pronounced. The testosterone levels in the male body drops by 2% every year after the age of 30-40.


Male menopause should more appropriately be referred to as the male climacteric period. Climacteric is the period of life when sex hormones are in decline (in women this is menopause). The term Male climacteric period was introduced by a Norwegian doctor August Werner at the beginning of the last century, and is sometimes also called andropause.


What are the symptoms?


It's important to note that not all men suffer from andropause. Only 2% of men report symptoms of male menopause. It is also crucial to bear in mind that some symptoms of male menopause could be confused with stress and a tight work schedule.


The symptoms of male menopause are similar to those of female menopause that kick off at the age of 35-40.


So, the most common symptoms of male menopause include (1):

  1. Mood swings and irritability;

  2. decreases muscle mass and endurance;

  3. enlargement of the breasts (appearance of the male breasts);

  4. lack of energy and apathy;

  5. problems with sleep and increased fatigue;

  6. decreased concentration span;

  7. decreased libido and erectile dysfunction;

  8. increased sweating.



What causes these symptoms?


The main reason for age-related testosterone drop in males is linked to a decrease in the number of testosterone-producing Leydig cells in testicles. On top of this, the existing Leydig cells reduce their testosterone production. This is due to a dysfunction in the pituitary gland and/or hypothalamus, which leads to a decrease in production of Luteinizing hormone, the hormone that stimulates testosterone production.


Late-onset hypogonadism could also cause the symptoms of the male menopause. This condition is characterised by a lack of or very low levels of sex hormones. Conditions like type 2 diabetes and obesity could be an underlying cause of late-onset hypogonadism. Sometimes, hypogonadism can occur during childhood, which subsequently leads to a late onset of puberty.


However, please note that late-onset hypogonadism is a pathological condition and not part of normal ageing processes. This condition is diagnosed by a blood test and requires hormonal treatment.


Treatment


So, what should you do if you suspect that you are affected by the symptoms of male menopause?


First and foremost, you should not feel embarrassed or shy about the fact that your organism is going through the normal ageing process. An endocrinologist will take some blood samples and guide you through all necessary steps that are required for the alleviation of the symptoms. Typically, the drop in testosterone levels is not critical, in which case cognitive behavioural therapy (CBT), sport and exercise and an active lifestyle could solve the problem. In case of a more significant drop in testosterone levels you could be prescribed hormonal therapy.


Hormonal therapy and risks of cardiovascular diseases in males


It is a known fact that the rate of women dying from cardiovascular disease is significantly lower than in men. This trend is especially apparent over the age of 40, when most women enter the perimenopausal period. Research therefore speculates that lower testosterone levels in men over 40 could increase the risk of cardiovascular disease in men.


Some studies have shown that men on testosterone replacement therapies have a lower risk of developing cardiovascular pathologies. Subsequent studies on mice and Drosophila (fruit flies) have shown that testosterone has some sort of protective mechanism against cardiovascular diseases (2). However, to date concrete evidence to support the hypothesis that testosterone hormonal therapy decreases chances of heart diseases is still weak.


To sum up, the existence of male menopause highlights the fact that both men and women go through some hormonal changes from their 40s onwards, which means that we should be more understanding towards both sexes and offer help and support to each other.



  1. Gould DC, Jacobs HS, Petty R. The male menopause—does it exist? ForAgainst. Bmj. 2000 Mar 25;320(7238):858-61.

  2. Gould DC, Jacobs HS, Petty R. The male menopause—does it exist? ForAgainst. Bmj. 2000 Mar 25;320(7238):858-61.

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