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Male Menopause

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Male Menopause

Male menopause is an informal term used for a condition caused when testosterone levels decrease in aging men. Experts disagree on how widespread the condition is. Some say only around 2 percent of men older than 60 have below-normal testosterone levels. Others say 40 to 80 percent of men older than 70 have it. The Endocrine Society estimates that millions of American men don’t produce enough testosterone.

What is testosterone?

Testosterone is the male sex hormone responsible for male characteristics. It triggers the penis and testicles to form in a fetus. At puberty, it causes the penis and testicles to grow larger. It also causes facial and pubic hair to grow, the voice to deepen, and muscle mass and strength to increase. It governs where fat is distributed on the body and oversees the increase in body height that occurs during adolescence. Testosterone also controls sex drive and sperm production.

Testosterone is made by the testicles. A small amount also is made by the adrenal glands, located on top of the kidneys. (In women, small amounts of testosterone are made by the ovaries.)

Testosterone production is controlled by a complicated process that begins in a part of the brain called the hypothalamus. The hypothalamus sends a hormone called gonadotropin-releasing hormone (GnRH) to the pituitary gland. The pituitary gland makes luteinizing hormone (LH), which signals the testicles to make testosterone. When there is enough testosterone, the hypothalamus sends a message to the pituitary glad to stop making LH, and the testicles slow down production of testosterone. In an adult male, about 7 mg of testosterone is made each day.

Testosterone production reaches its peak during adolescence and young adulthood. The range of what is considered a “normal” level of testosterone varies widely. Testosterone levels usually decline as a man ages, but never drop to zero, as estrogen does for a woman when she reaches menopause.

What causes low testosterone?

In young men, a testosterone level that is too low can be caused by genetic conditions such as:

  • Klinefelter's syndrome. A condition in which men have an extra X chromosome.

  • Hemochromatosis. A disorder in which too much iron is deposited in body tissues, including the pituitary gland.

  • Kallmann's syndrome. A genetic condition that affects the X chromosome in men.

  • Prader-Willi syndrome. A disorder in which the genitals are underdeveloped; often testes don’t descend.

  • Myotonic dystrophy or adult muscular dystrophy

Other causes in young men include:

  • Trauma to the testicles

  • Inflammation of the testicles often caused by getting mumps after puberty

  • Radiation treatment or chemotherapy

  • Treatment of tumors of the testicles

  • Castration for cancer of the testicles or prostate

  • Tumors of the pituitary gland

  • Medications, such as narcotic pain medications, prednisone and anabolic steroids

  • HIV/AIDS

  • Medical conditions, such as tuberculosis, fungal infection, and autoimmune disease that affects the pituitary gland

Aging causes a normal decrease in the production of testosterone in men. This is sometimes called andropause. Andropause usually occurs between the ages of 40 and 55. Beginning around the age of 40, testosterone production decreases by about 1 percent each year.

What are the symptoms of low testosterone?

The normal decline in testosterone because of aging causes some men's hormone levels to go down more than others. Some men have more symptoms than other men. Symptoms of low testosterone in older men can also be symptoms of many other conditions.

Talk to your health care provider if you have any of these symptoms:

  • Progressive decrease in muscle mass

  • Decrease desire or interest in sex (libido)

  • Erectile dysfunction

  • Weight gain

  • Problems sleeping

  • Feeling irritable or angry

  • Loss of motivation

  • Loss of drive at work

  • Nervousness

  • Problems with memory and concentration

  • Indecisiveness

  • Lower self-confidence

  • Tiredness

  • Depression

  • Mood swings

  • Loss of energy

  • Bone loss

How is low testosterone diagnosed?

A simple blood test can determine your testosterone level. The serum total testosterone test is the most common. This test should be done in the morning, when the testicles usually release more testosterone. Normal results usually range from 300 to 1000 ng/dL (or 10 to 38 nmol/L). A total testosterone level that is repeatedly less than 250 ng/dL (8.5 nmol/L) indicates a very low level of testosterone production. Treatment to replace testosterone may be needed. Because a normal level of testosterone is different for each man, however, it may be hard to know if you have low testosterone with just one test; you may need several tests taken over time.

About 98 percent of the testosterone carried in the blood is bound to two proteins and is not available to the tissues of the body. The remaining 2 percent, which circulates freely, causes the effects on body tissues. As men age, more testosterone is bound by proteins. Too little free testosterone can cause the symptoms listed above.

What is the treatment for low testosterone? 

For men whose testicles produce too little or no testosterone (a condition called hypogonadism), health care providers may prescribe testosterone replacement therapy (TRT). TRT works to restore sex drive, fertility, muscle strength, and prevent bone loss. But the long-term benefits and risks of TRT in healthy, aging men have not been studied.

In the majority of short-term studies, TRT decreased a man’s fat mass, increased muscle mass, improved strength, and increased bone mineral density. Because ED usually has causes other than low testosterone, TRT does not help in the majority of ED cases.

High doses of testosterone can cause sleep problems and infertility, and increase the risk for stroke. In addition, high doses of testosterone may cause benign (noncancerous) growth of the prostate gland. This can lead to a condition called benign prostatic hyperplasia. If an undetected prostate cancer is present, experts worry that TRT could cause rapid growth of the cancer. Acne can also be a side effect of TRT.

TRT can be given by injections every two to three weeks; by skin patches; and by implanted pellets that are inserted every four to six months. A recently approved form of testosterone is by tablet and placed under the tongue or beside the gum. Testosterone is not given orally because it can affect the liver, raise total cholesterol levels, and decrease high density lipoprotein (HDL) levels, the “good” cholesterol.