The 'male menopause' 

  • Overview

Introduction 

Male sexual dysfunction

Don't suffer in silence with erection problems or premature ejaculation: find out the causes and treatments

Some men develop depression, loss of sex drive, erectile dysfunction and other physical and emotional symptoms when they reach their late 40s to early 50s. 

Other symptoms common in men this age are:

  • hot flushes
  • mood swings
  • loss of muscle mass
  • fat redistribution, such as developing a large belly or "man boobs" (gynaecomastia)
  • tiredness and a general lack of enthusiasm or energy
  • increased sweating
  • poor concentration and short-term memory
  • irritability

These symptoms can interfere with everyday life and happiness, so it's important to find the underlying cause and work out what can be done to resolve it.

Is there such a thing as a 'male menopause'?

The "male menopause" (sometimes called the "andropause") is an unhelpful term sometimes used in the media to explain the above symptoms.

This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause. This is not true. Although testosterone levels fall as men age, the decline is steady  less than 2% a year from around the age of 30-40  and this is unlikely to cause any problems in itself.

A testosterone deficiency that develops later in life (also known as late-onset hypogonadism) can sometimes be responsible for these symptoms, but in many cases the symptoms are nothing to do with hormones.

Personal or lifestyle issues 

Lifestyle factors or psychological problems are often responsible for many of the symptoms described above.

For example, erectile dysfunctionloss of libido and mood swings are often the result of stress, depression or anxiety. These psychological problems are typically brought on by work or relationship issues, divorce, money problems or worrying about ageing parents.

A "midlife crisis" can also be responsible. This can happen when men think they've reached life's halfway stage. Anxieties over what they’ve accomplished so far, either in their job or personal life, can lead to a period of depression. In men, this usually happens between the ages of 35 and 50, and can last up to 10 years. Read more about the male midlife crisis.

Other possible causes of the above symptoms include:

  • lack of sleep
  • poor diet
  • lack of exercise
  • drinking too much alcohol
  • smoking
  • low self-esteem
  • diabetes

Late-onset hypogonadism 

In some cases, where lifestyle or psychological problems do not seem to be responsible, the symptoms of the "male menopause" may be the result of an underlying medical problem, where the testes produce few or no hormones. This is known as hypogonadism.

Hypogonadism is sometimes present from birth, which can cause symptoms like delayed puberty and small testes.

Hypogonadism can also occasionally develop later in life, particularly in men who are obese or have type 2 diabetes. This is known as late-onset hypogonadism and it can cause the "male menopause" symptoms mentioned above. However, this is an uncommon and specific medical condition that is not a normal part of ageing.

A diagnosis of late-onset hypogonadism can usually be made based on your symptoms and the results of blood tests used to measure your testosterone levels.

What to do

If you are experiencing any of the above symptoms, see your GP. They will ask about your work and personal life, to see if your symptoms may be caused by a mental health issue, such as stress or anxiety.

If stress or anxiety are affecting you, you may benefit from medication or a talking therapy, such as cognitive behavioural therapy (CBT). Exercise and relaxation can also help. Read about stress management, treating anxiety and help for low mood and depression.

Do I need HRT?

Your GP may also order a blood test to measure your testosterone levels. If the results suggest you have a testosterone deficiency, you may be referred to an endocrinologist (a specialist in hormone problems). 

If the specialist confirms this diagnosis, you may be offered testosterone replacement treatment in the form of tablets, patches, gels, implants or injections to correct the hormone deficiency, which should relieve your symptoms.

Page last reviewed: 20/03/2014

Next review due: 20/03/2016

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Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User896039 said on 15 August 2014

In reply to Nemesis65 below.

I have found that it is definitely not the case that Metformin causes ED.

For over 20 years I was wrongly diagnosed with CFS - I would often experience hot flushes - and when that occurred would experience ED. In Jan this year I was diagnosed with Type 2 (they now believe I was "borderline" for all those years) and prescribed Metformin.

I seem to be doing pretty well understanding my Diabetics - if I eat too many Carbs my flushing begins and that is when I experience ED. When I keep my blood sugars in check, I experience no hot flushes and no ED - despite a regular dose of Metformin.

I currently am waiting on hormone level results.

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RaspberryFieldsForever said on 29 May 2014

Thank You Nemesis65 for your comments below.
I was diagnosed with Type 2 Diabetes approximately 6 years ago, and although in general have not had many of the listed side effects, I have recently (last year or so) had problems with ED, which was definitely not an issue when I was younger. I am now 59,and although I accept that things do not work as well as you grow older, I feel that I am still too young for this to be happening, especially when you can read articles elsewhere of men having great sex in their 70`s !
I also have Colitis, and had put my problem down to a combination of having both illnesses and also the mixture of tablets I take to keep them both stable, but I had never considered that the problem might lie with Metformin.....I will be doing more research on this, and will definitely be mentioning this to my doctor/nurse at my next appointment ! So Thank You again Mr Nemesis, I will update when I have more news to share....

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Nemesis65 said on 21 March 2014

I agree with the comments blow that most GPs are pretty clueless about this subject and that the NHS does its very best to avoid giving treatment for low testosterone. It is usually dismissed as a patient lifestyle problem rather than something else.

There is also another grubby little secret that the NHS does not acknowledge and dismisses in that people with type two diabetes will be told that it is their diabetes which is causing ED and / or low testosterone. In fact it is in all probability the drug Metformin.

The NHS has tried to cover this up for years as Metformin is a very cheap drug (each tablet only costs the NHS two pence). However, Metformin has some terrible unacknowledged side effects including ED and low testosterone as the drug blocks the effective absorption of many of the key building blocks of testosterone including zinc, magnesium along with most vitamins.

When I challenged my GP about this I was told it was probably my blood glucose levels even though they are stable and fairly low. My response was that I would stop taking Metformin at which point panic set in at my surgery and they agreed to blood tests.

The NHS has tried to hide the issues around Metformin as it has blighted many people's lives (particularly men) for many, many decades. The drug was discovered in the 1920's and nothing from that time has proved to be reliable.

My own view is that the NHS has hidden these side effects to prevent people taking legal action for their damaged lives.

I personally had no problems with ED and had a healthy sex life until I was prescribed Metformin

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neilsmith38 said on 28 February 2014

Another set of patients have hypogonadism all their lives.

Kallmann syndrome is a rare genetic condition, affecting about one in 50,000 people. People with Kallmann syndrome do not go through puberty. It is also associated with a lack of sense of smell.

Kallmann syndrome can sometimes be classed as a secondary hypogonadal condition as even though the testes are small, under developed and dormant they can still function correctly with the appropriate treatment.

The problem lies with the lack of gonadotropin signal from the pituitary gland (LH and FSH) which normally stimulates the testes into activity.

There is no reliable genetic or blood test for Kallmann syndrome so diagnosis is normally made by exclusion of other possibilities. Patients with Kallmann syndrome are often dismissed as "late starters" or "late developers".

Hormone replacement therapies are available, normally in the form of an injection taken every three months to raise testosterone levels to normal. The majority of patients would require life long treatment to prevent the risk of developing osteoporosis and diabetes.

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leydig said on 28 December 2013

hello guys
do any of you happen to frequent any other forums on the issue of hypogonadism ?? as i would like to confer with other nhs patients.
i've been hypo since about 2000 secondary to chemo therapy for hodgkins. mild leydig cell damage, severe sertoli cell damage caused by toxic insult.
i need to get some advice, as a specilist i saw recently was the most dismissive dr. i've ever come across. insisting that the nhs would not treat me.
i'm not just going to roll over and accept this.
especially as my local CCG have written to my GP giving funding for treatment.

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Sarky said on 05 December 2013

There are some problems here as you have disregarded the terminology of both Primary Hypogonadism (PH) and Secondary Hypogonadism (SH) in favour of a general overview. Klinefleter's Syndrome is recognised to be the most common cause of PH while SH is more likely to be caused by some degree of life style choices. In the original hypothesis exploring the concept of there even being a life style choice the estimated annual decline in testosterone was given as 0.5% and by default all persons with a hormonal disorder were excluded from this study. So surely including both PH and SH under the same heading has to be somewhat inept.

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ommanipadmehum said on 18 October 2013

Speculation regarding the relationship between stress / anxiety disorders and hypogonadism.

I speculate that in some individuals, a natural drop or slight to severe deficiency of Testosterone may actually be the precursor to anxiety or stress disorder.

I hypothesize that low or lower than normal testosterone can expose stress hormone sensitive areas of the brain (such as the hypothalamus) to elevated levels of stress hormones such as cortisol.

Numerous clinical studies of past have presented conclusive evidence that exposing the brain to prolonged elevated cortisol levels results in brain damage to the areas of the brain that deal with stress and stress hormones such as the hypothalamus / hippocampus.

Therefore, i would also like to speculate that the development of more accurate ways to measure testosterone and the practice of tracking peoples testosterone levels constantly with the aim of developing methods of maintaining optimum levels for each individuals could be preventative medicine of the future that not only prevents hypogonadal type symptoms but loads of other related conditions including depressions, anxiety and dementia.

Please consider and take seriously.
Open up books and research if necessary!

Thanks.

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ommanipadmehum said on 17 October 2013

I also agree with XXYZGuy's comment bellow.

Klinefelter is not age related and not all cases of Hypogonadism is either.

Some people's low testosterone is age related however other people are born with the condition.
In addition, some people develop the condition due to a malfunction somewhere within their hippo-campus/pituitary gland/testes axis.

I, for example, have been diagnosed with Hypogonadism at the age of 38. Although I was likely suffering from the condition either since I was born or since puberty.

for the last 20 years I have been prescribed various types of anti-depressants to treat the disorder although I still exhibited hypogonadal symptoms:
i.e. fatigue, loss of libedo, cognitive impairment, chronic irritability, extended requirement for sleep. Less body hair. Extra fat. Inability to put on muscle on the upper body.

The anti-depressants do not cure hypogonadism.

All people with the above symptoms including anxiety should be given the option of paying for a blood test to test testosterone levels!

This would save peoples lives being wasted!

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ommanipadmehum said on 17 October 2013

I have read extensively on the subject of Testosterone Deficiency / Hypogonadism and feel that some of the information stated above is complete nonsense.

I also feel that the vast majorities of GP's in the UK know very little about the subject and are not qualified to make an accurate diagnosis.

The statement in the above article that Low Testosterone is caused by stress or anxiety is unfounded. I would also note that most other official sources on the subject list chronic irritability and vulnerability to anger as symptoms as well.

What is the difference between chronic irritability and stress? If you went to almost all GPs in the UK presenting them with the above symptoms you will likely be diagnosed with anxiety/depression/chronic fatigue (if you are lucky) or manic depression or one of the many other more serious delusional mental health disorders (if you are unlucky) while in reality you will be suffering from Hypogonadism.

Firstly being diagnosed with one of the above disorders will be unpleasant and possibly life ruining,
however, what will make things worse is that the various medications and treatments to treat the above disorders will not cure your hypogonadism!

So, you will still be suffering from hypogonadism and you now will be spaced out on the new meds,
and possibly going to see a psychologist to get therapy that will never cure your symptoms!

Going through all of this can really damage your life. You can lose your partner, your job and end up living on the fringe classified as mentally ill when you are actually suffering from a treatable disorder!

The only thing that will help is Testosterone Replacement Therapy!

I recommend any one who is worried about this condition, regardless as to whether they are also suffering from anxiety and stress,
to first read the book called Testosterone for Life by MD Morgentaler and to go see an experienced specialist who uses Analog Free Testosterone Tests.

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XXYZGuy said on 16 September 2012

I have to disagree, sorry:

"Klinefelter's syndrome (a rare genetic condition where a man is born with an extra female chromosome). In other words, it is not just a normal age-related change."

Which is, ahem, nonsense.

XXY is very common, 1:500 to 1:1000 live male births, although not all will go on to develop the syndrome, so the syndrome will be less common.

Also, even though gynaecomastia is a feature of Klinefelter's syndrome, most boys who develop it in the UK, do not have examinations of their genitals, which would reveal all males with Klinefelter's syndrome if the doctor associated small firm testes with the karyotype XXY.

So probably the reason why you think Klinefelter's syndrome is very rare is because doctors generally do not examine male sexual development as routine. Male sexual health is not a priority. That's a world wide trend by the way.

Maybe you'd like to get something going with your doctors and make mens sexual health more prominent?

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