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Male ‘Menopause’ - is there such a thing?

Updated: Mar 2, 2023

While menopause is a term describing a period of time in a women's hormone transition,

low libido, erectile dysfunction, fatigue, lowered physical endurance and some emotional symptoms can affect men, especially in their 40s and early 50s.


Other symptoms that can affect a man's quality of life may include:

  • poor sleep

  • irritability

  • low mood

  • loss of muscle mass or difficulty gaining muscle despite adequate exercise and nutrition

  • loss of motivation or interest

  • loss of vitality

  • fat redistribution to the chest or development of ‘man-boobs’


You may have also heard of the term ‘Andropause’ being assigned to low levels of testosterone causing these symptoms in men. However, this is not an accurate description as it implies that all these symptoms are a result of low testosterone only and that all men will experience this. But this is not the case.

A clinical condition called hypogonadism can occur either early in life or at a later age, but this is not common, and does not affect all men (1). There are specific clinical

guidelines on how to assess and manage this condition (2).


While the levels of testosterone declines steadily at a rate of 2% per year in men from their 30s to 40s, blood screening for testosterone levels is not recommended without clinical symptoms as there are many different factors that can affect testosterone levels.


Many of the above symptoms experienced by men may be associated with other conditions and lifestyle habits. These may include:

  • lack of sleep quantity and quality

  • lack of physical activity or excessive exercise

  • excessive alcohol intake

  • smoking

  • poor diet or restrictive eating patterns leading to low energy availability

  • stress

  • being overweight or obese

  • diabetes

  • high blood pressure

  • depression

  • anxiety

  • certain medications


A condition known as metabolic syndrome, which includes high blood pressure, high cholesterol, increased waist circumference, insulin resistance/ pre-diabetes increases the risk of heart disease, stroke and diabetes. These conditions are often found together with low testosterone levels and erectile dysfunction. The frequency of metabolic syndrome peaks in men from age 40 and continues to increase with age.


The early stages of metabolic syndrome may not lead to symptoms, but if discovered early, can be treated, mitigating the progression to the above cardio-metabolic conditions.


Chronic stress can often result in a down-regulation of the hypothalamic-pituitary-thyroid-gonadal axis overlapping with many of the symptoms associated with low testosterone and identifying these upstream effects are part of a holistic approach.

If you are in your 40s or experience any of the above symptoms affecting your quality of life, energy or vitality, speak to your health practitioner for a detailed assessment. But do not stop taking prescribed medications until you see a doctor.


A doctor trained in lifestyle or integrative medicine will often go through an in-depth health and lifestyle questionnaire with you, and where appropriate, arrange blood work, further testing or a referral to a specialist, to identify the root cause. It is important to remember that the results of testing should always be interpreted in context of your specific symptoms, especially hormone levels. The reason is due to the natural fluctuations of hormones throughout the day and blood tests can only pick up a level at one point in time. As mentioned, testosterone levels are only one aspect of the entire hormonal axis, concentrating on only one biomarker without context can lead to lack of sustainable long-term results and even side effects.



There are some specific strategies that has been shown to support healthy testosterone levels naturally, and these include:

  • getting sufficient sleep between 7-9 hours. Men who get less than 6 hours sleep have smaller testicular size and testosterone levels or men who are 10 years older (3,4)

  • both aerobic endurance and resistance/ weight training exercises, supports a healthy weight, improves physical fitness and muscle growth regardless of changes in testosterone levels (5)

  • Ensure adequate calories, macronutrients and micronutrients if engaging in vigorous or higher intensity physical activity and balance with appropriate recovery

  • eating an anti-inflammatory diet in combination with healthy lifestyle habits can prevent erectile dysfunction (6).

  • managing stress as cortisol, the stress hormone, and its relationship to testosterone is a useful biomarker for overall physical health, mental health and athletic performance. Studies show that higher levels of cortisol are associated with burnout (7)

  • Maintain a healthy weight, and especially avoid belly fat as this is an independent risk for cardio-metabolic disease

Many of the above strategies require making choices and behavioural changes. Working with your doctor to gain knowledge and a certified health coach can help reduce the overwhelm when implementing these changes, provide support, accountability and build your confidence in making sustainable improvements to your health.


References:

  1. Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, Snyder PJ, Swerdloff RS, Wu FC, Yialamas MA. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-1744. doi: 10.1210/jc.2018-00229. PMID: 29562364.

  2. Livingston, M, Kalansooriya, A, Hartland, AJ, Ramachandran, S, Heald, A. Serum testosterone levels in male hypogonadism: Why and when to check—A review. Int J Clin Pract. 2017; 71:e12995. https://doi.org/10.1111/ijcp.12995

  3. Zhang W, Piotrowska K, Chavoshan B, Wallace J, Liu PY. Sleep Duration Is Associated With Testis Size in Healthy Young Men. J Clin Sleep Med. 2018 Oct 15;14(10):1757-1764. doi: 10.5664/jcsm.7390. PMID: 30353813; PMCID: PMC6175801.

  4. Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011 Jun 1;305(21):2173-4. doi: 10.1001/jama.2011.710. PMID: 21632481; PMCID: PMC4445839.

  5. Riachy R, McKinney K, Tuvdendorj DR. Various Factors May Modulate the Effect of Exercise on Testosterone Levels in Men. J Funct Morphol Kinesiol. 2020 Nov 7;5(4):81. doi: 10.3390/jfmk5040081. PMID: 33467296; PMCID: PMC7739287.

  6. Di Francesco S, Tenaglia RL. Mediterranean diet and erectile dysfunction: a current perspective. Cent European J Urol. 2017 Jun 30;70(2):185-187. doi: 10.5173/ceju.2017.1356. Epub 2017 Jun 11. PMID: 28721287; PMCID: PMC5510347.

  7. Noushad S, Ahmed S, Ansari B, Mustafa UH, Saleem Y, Hazrat H. Physiological biomarkers of chronic stress: A systematic review. Int J Health Sci (Qassim). 2021 Sep-Oct;15(5):46-59. PMID: 34548863; PMCID: PMC8434839.

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