Andropause – Myth or reality?

Men experience age-related hormonal changes that are quite different from those women experience. The terms male menopause, andropause, testosterone deficiency, androgen deficiency and late-onset hypogonadism are all used to refer to a lack of testosterone that can be normal or pathological. So, is andropause fact or fiction?

Hormonal changes are a normal part of the aging process. Female menopause is quite different from andropause, however. When they stop ovulating, women go through a major drop in the level of hormones circulating in their body, and this occurs over a relatively short period of time. Conversely, men usually experience a slow and gradual drop in the level of testosterone circulating in their body, over the course of several years. As a result, the effects on men – such as changes in sexual function, level of energy or mood – tend to be subtle and go unnoticed for years.

Testosterone levels vary greatly from one man to another. Generally speaking, older men tend to have lower blood levels of male hormones than their younger peers. Testosterone levels gradually decrease throughout adult life, by about one percent per year after the age of 30. Around age 70, a drop of up to 50 percent may occur.

While a decline in testosterone levels is usually considered normal and causes few symptoms, some cases are considered pathological. A medical assessment may therefore be necessary in order to check whether a medical problem is causing the decrease.

Recognizing the symptoms of a drop in testosterone levels

Some men with abnormally low testosterone levels show no signs or symptoms. In others, low blood levels of testosterone can cause one or more of the following:

- Changes in sexual function, including lower libido, fewer spontaneous erections (e.g. upon waking) and infertility. A reduction in testicle size is sometimes noted.

- Changes in sleep patterns, insomnia in particular.

- Physical changes such as an increase in body fat and a decrease in muscle mass, strength and bone density. A tense or swollen chest is also possible, as are hot flashes and a lower energy level.

- Emotional changes that manifest mainly as decreased motivation and self-confidence, sadness, depressed mood, and loss of concentration or memory.

It is important to note that some of these signs and symptoms are part and parcel of normal ageing. Others may have various causes, including a thyroid disorder, depression, or excessive alcohol consumption. A medical exam can help identify what’s “normal” and what isn’t.

What about testosterone supplements?

It is well known that women in early menopause can take hormone supplements to help relieve bothersome symptoms like hot flashes. There is a price for those benefits, however, as adverse effects include a greater risk of developing breast cancer. This is why hormone replacement therapy is only prescribed for as short a time as possible, in women who need it and have no contraindications.

When the drop in testosterone levels is caused by a health problem, hormone levels may be restored once the health condition is treated. Otherwise, testosterone supplements can be considered. Treating an age-related testosterone deficiency remains controversial, however. In some men, a testosterone supplement may alleviate certain bothersome symptoms associated with a testosterone deficiency. These supplements must be taken under medical supervision and are most commonly offered in the form of injections, gels or skin patches. Some of the effects of these supplements include increased muscle mass and improved memory, concentration, libido and energy levels. While the list of benefits appears very attractive, studies published to date on these supplements have not shown clear benefits in compensating for age-related testosterone decline. In addition, they may increase the risk of prostate cancer and other health problems. Caution is therefore advised.

How are things in bed?

It’s normal for men to notice a gradual decline in their libido as they age. This may include a need for more stimulation in order to get or maintain an erection, shorter orgasms and erections that are not as firm. Although interest in sex varies greatly from one person to another, it is still very active in the majority of older men. Age-related changes are not an insurmountable obstacle to a satisfying sex life.

A loss of libido is sometimes due to a health problem such as depression or the use of certain medications. Maintaining good overall health therefore increases the odds of having a satisfying sex life. Varying the routine, communicating openly with your partner and remaining positive are all helpful in maintaining fulfilling intimate relationships.

Your doctor is the best person to evaluate the possible causes of a sexual disorder and to identify possible solutions. Keep in mind that Viagra® isn’t the only option! Sex is probably not the same now as it was when you were forty, but with some adaptation, intimacy with your partner can remain a pleasurable part of your life.

Being at your best

If you suspect that you may have symptoms of a testosterone deficiency, speak to your doctor, who will perform a medical check-up. Testosterone production cannot be increased, but there are other ways to increase your well-being.

- Be honest with your doctor and work together to identify the possible causes of your signs and symptoms.

- Adopt a healthy lifestyle. Healthy eating and regular physical activity both help maintain your physical strength, a healthy body weight and your energy level, while also improving your concentration and mood, and promoting restorative sleep.

- Seek help if you feel melancholic. Depression does not always manifest as sadness, however. Other manifestations include being irritable, isolating yourself, taking refuge in excessive work, drinking too much alcohol, using illicit drugs or consciously seeking risky activities.

In the end, is andropause fact or fiction? One thing is certain: Andropause remains a controversial topic. We could summarize, however, by saying that normal ageing involves a gradual decline in testosterone levels in most men. In some cases, this decrease may be more notable and may cause bothersome symptoms.

If you have questions regarding andropause or male ageing in general, do not hesitate to broach them with your pharmacist or physician.