When a woman transitions through menopause, symptoms, such as hot flashes, an abrupt end to her menstrual cycle, and new-onset psychological or cognitive changes, indicate that her estrogen levels are dropping. This begs the question, “Do men experience a menopause equivalent?”
If they do, should we call it menopause, manopause, or andropause? While it’s clear that testosterone levels decline in men as they age, what causes that decline and whether the symptoms a man experiences directly result from that decline are less clear.
Testosterone, progesterone, and estrogen, the hormones typically associated with male and female reproduction and fertility, decline with age.
Women have fluctuating levels of estrogen and progesterone that are tied to the reproductive cycle throughout the reproductive years. When ovulation ceases, a condition known as menopause, a woman’s hormone levels decline rapidly.
Men have high levels of testosterone that peak in their 30s and then slowly decline with age. In men, there is no equivalent reproductive marker to female menopause. A more accurate term would be late-onset hypogonadism or partial androgen deficiency of aging males (PADAM). This term refers to a decline in testosterone level with aging, but does not imply that symptoms are attributable to this decline or that medical treatment should be considered. The lack of evidence for an exact criterion for a menopause equivalent in men is why the term remains controversial.
In one study that enrolled 3,369 participants, only 2.1% experienced the symptoms of late-onset hypogonadism. The decline in testosterone appears to be fairly consistent in men. However, symptoms do not, suggesting other factors are important.
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Manopause or andropause are terms applied to symptoms a man may experience as his testosterone levels decline with age. Unlike the clear definition of female menopause as well as the symptoms and potential treatments associated with it, manopause is a misnomer as it attempts to describe an equivalent experience in men. Unlike women, men can maintain their fertility well into old age. Paternity has been documented in men in their 90s.
A man’s testosterone level declines by an average of 1% per year after age 40 or so. Even with this decline, only about 10% to 25% of men have a measurably low testosterone level. A quarter of men over the age of 75 have testosterone levels comparable to the upper quartiles in young men.
To further complicate matters, some men with low testosterone levels go undiagnosed and untreated. Some men have low testosterone levels but experience no symptoms. Some men have symptoms that may not be directly attributable to low testosterone levels.
There are physical and psychological symptoms attributed to the decline in sex hormones in both men and women. The symptoms in women are well-defined and are listed here for comparison’s sake.
Read More: Cognitive Symptoms in Menopause
As mentioned, in most cases, there is no clear association between a decline in testosterone levels and physical and psychological symptoms attributed to male menopause. Nonetheless, men describe these symptoms fairly predictably.
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Testosterone levels generally decline in men after the age of 40. However, the rate of decline in all men is not the same. Because the decline is not consistent and there is no threshold number that is correlated with symptoms, an age-related decline in testosterone levels is not felt to be the direct cause of the symptoms some men experience.
The prevalence of low testosterone levels in men in the United States is reported to be approximately 20% in men over age 60, 30% in men over age 70, and 50% in men older than age 80.
Chronic illness, psychological factors, lifestyle choices, and medication use are likely to explain many of the symptoms men might experience with aging. Some contributing lifestyle factors are:
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Psychological factors that may contribute to the symptoms associated with male menopause include:
Medical conditions and their treatment can also cause symptoms that overlap with those attributed to low testosterone levels. Examples include:
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In 2020, the American College of Physicians (ACP) made the following recommendations regarding the diagnosis and treatment of men with low testosterone levels.
ACP recommends that clinicians discuss the risks and benefits of starting testosterone treatment with men who have age-related low testosterone levels and sexual dysfunction.
ACP recommends that men receiving treatment for age-related low testosterone should receive intramuscular treatment rather than transdermal formulations.
They recommend that men should have their symptoms re-evaluated after 12 months on testosterone treatment and periodically after that. If there is no improvement in symptoms, then testosterone treatment should be discontinued.
Read More: Testosterone Replacement Therapy (TRT)
Testosterone treatment is not recommended for men who have a history of breast or prostate cancer, untreated severe sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, elevated hematocrit, thrombophilia, or a recent heart attack or stroke.
ACP does not recommend initiating testosterone treatment to improve energy, vitality, physical function, or cognition. Instead, for these symptoms, look for lifestyle factors that can be improved to improve overall health.
Read More: 7 Ways to Naturally Regulate Your Hormones
The Endocrine Society also recommends testosterone treatment in men with symptoms and signs consistent with low testosterone levels. As with all medical treatment options, discuss your symptoms with your doctor and ask whether your testosterone levels should be checked. Then discuss the risks and benefits of starting testosterone therapy.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.