What does ‘male menopause’ mean?

Hormone changes are a natural part of aging, but the experience is different for men and women. Unlike the more dramatic plunge that occurs in women during menopause, sex hormone changes in men occur gradually. This is sometimes called male menopause.

For women, menopause marks the end of their menstrual cycles, whether by naturally declining reproductive hormones, surgical removal of the ovaries, changes caused by chemotherapy or radiation therapy, or a condition called primary ovarian insufficiency. Ovulation ends and hormone production plummets during a relatively short period of time.

In men, production of testosterone and other hormones declines over a period of many years and the consequences aren’t necessarily clear. This gradual decline of testosterone levels is called late-onset hypogonadism or age-related low testosterone.

Recognizing low testosterone levels

A man’s testosterone levels decline on average about 1% a year after 40. However, most older men still have testosterone levels within the normal range, with only an estimated 10% to 25% having levels considered to be low.

Low testosterone levels in older men often go unnoticed. Testosterone levels can be checked by a blood test, but tests aren’t done routinely. And many men who have low testosterone levels experience no symptoms. In addition, the signs and symptoms associated with low testosterone aren’t specific to low testosterone. They also can be caused by a person’s age, medication use, or other conditions, such as having a body mass index of 30 or higher.

Signs and symptoms suggestive of low testosterone include:

• Reduced sexual desire and activity.
• Decreased spontaneous erections or erectile dysfunction.
• Breast discomfort or swelling.
• Infertility.
• Height loss, low trauma fracture or low bone mineral density.
• Hot flushes or sweats.

Other possible symptoms include decreased energy, motivation and confidence; depressed mood; and poor concentration. It’s also possible to experience increased sleepiness; sleep disturbances; mild, unexplained anemia; reduced muscle bulk and strength; and increased body fat.

Experts recommend only testing older men for low testosterone if they have signs or symptoms. If an initial test shows low testosterone, the test should be repeated to confirm the results. If low testosterone is confirmed, further testing of the pituitary gland is recommended to determine the cause and rule out other hormone deficiencies. The pituitary gland is a kidney-bean-sized gland situated at the base of your brain. It is part of your body’s endocrine system, which consists of all the glands that produce and regulate hormones.

Treatment

Recommendations on testosterone therapy for men with age-related low testosterone vary. In 2020, the American College of Physicians recommended that health care professionals consider starting testosterone treatment in men with sexual dysfunction who want to improve their sexual function, after explaining the risks and benefits. In 2018, the Endocrine Society recommended testosterone therapy for men with age-related low testosterone who have signs and symptoms associated with low testosterone.

Some experts also recommend offering testosterone treatment to men with age-related low testosterone without the presence of signs or symptoms.

If you choose to start testosterone therapy, your health care professional will explain the different ways testosterone can be administered, target levels and follow-up testing.

For some men, testosterone therapy relieves bothersome signs and symptoms of testosterone deficiency. For others, the benefits aren’t clear, and there are possible risks.

Though further research is needed, testosterone therapy might stimulate growth of metastatic prostate and breast cancer. Testosterone therapy also may increase the risk of heart attack and stroke and contribute to the formation of blood clots in the veins.

Your health care team likely will recommend against starting testosterone therapy if your fertility is important in the near future or if you have conditions such as breast or prostate cancer, untreated severe obstructive sleep apnea, uncontrolled heart failure, or thrombophilia, or if you’ve recently had a heart attack or stroke.

If you think you might have low testosterone, talk to your health care team about your signs and symptoms, testing, and possible treatment options. They can help you weigh the pros and cons of treatment.