Male menopuase - fact or fantasy?

Manopause – fact or fiction?

We all know that women will have a menopause, usually in the late 40’s, marked by the end of menstruation and sometimes many other symptoms such as hot flushes and irritability. What about men, do they also have a ‘manopause’? The facts indicate that they certainly undergo some changes later in life.

The changes which have earned the name ‘Male menopause’ or andropause, are due to a gradual decrease in testosterone levels beginning in middle age. Unlike the female menopause which can be defined by the end of menstruation, there is no specific occurrence to define the male’s change of life. This decrease in testosterone may cause fatigue, weakness, depression, and may be one of many causes of erectile failure. Unlike the female menopause, men do not experience a complete cessation of reproductive ability, and many men are known to have fathered children into their 80’s.

It is estimated that by their mid-50s, about 30 percent of men experience some symptoms of andropause, in other words a decrease in testosterone levels. The staff of the Mayo Clinic report that testosterone levels decrease about 1 percent each year after the age of 30. Though individual testosterone levels vary among men, by the age of 70 a man's personal level is decreased by 50 percent.

While aging is the commonest cause, the most likely males to develop early andropause are those with diabetes, hypertension, and genetic disorders that produce hypogonadism, including Klinefelter's, Wilson -Turner, and Androgen insensitivity syndromes. Men who work in the pharmaceutical industry, plastics factories, near incinerators, and on farms that use pesticides are at high-risk for early andropause. Low testosterone levels can also be the result of untreated medical conditions such as obstructive sleep apnea.

How do I know whether I have it?

The usual symptoms are loss of libido and/ or erectile failure, fatigue, decreased muscle strength and mass with less ability to participate in sporting activities, depression, poor short-term memory and low self-esteem, abdominal weight gain, loss of body hair, diminished muscle mass and loss of height, - all readily attributed to normal aging. In addition there may be hot flushes, sweating, insomnia and nervousness. A simple blood test for testosterone levels may show lower than expected levels, and other changes may also be found such as increased LDL cholesterol, increased total body fat, osteoporosis and reduction in the red blood cells in the blood.

The 40’s and 50’s are also a time of social change, with children leaving home, retirement looming, signs of aging beginning to show, and many men have psychological difficulties adjusting to the fact that they are no longer young!

What is the usual Treatment?

Treatment of any underlying disorder, such as diabetes, obesity, alcohol misuse and smoking is important.  The usual treatment is hormone therapy with testosterone injections. However these are not without risk and replacement therapy could increase the risk of prostate cancer. (A PSA blood test can identify a man's risk for prostate cancer.) Other risks associated with testosterone supplementation [TRT], particularly with injections, include stroke, liver toxicity and breast development. See the article at

Cholesterol and red blood cell levels may also be affected by TRT and should be closely monitored. Other side effects of TRT are headaches, weight gain, acne and increased baldness. Ironically, testosterone supplementation also shuts down the production of sperm. Typically, Life Extension® suggests men target a blood level of testosterone between 700 and 900 ng/dL for optimal health.

 What other treatments are available?

There is plenty that the andropausal man can do for himself!

Increase your exercise and decrease your alcohol consumption.

For erectile dysfunction also get your blood sugar checked, and stop smoking! Smoking and diabetes accelerate thickening of the arteries, and effectively reduce the blood supply to the genitals, so that erection cannot happen. Erectile failure [impotence] on its own has many causes, and invariably has a large psychological overlay. Men tend to fear that they are failures after one episode, and ‘sit on their own shoulders’ as it were, wondering whether it will ever work again, when in fact all it was was a single episode after too much beer. If communication in the bedroom is lacking, then try to open up by discussing your sex life with your partner. There are books available, as well as sex therapists in the major centres. So often a sexual problem is a reflection of poor communication in the whole relationship, and by opening up those channels, a whole new aspect of your relationship together may develop.

A daily regimen of 30-50 milligrams of zinc picolinate or citrate, 40,000-50,000IU of vitamin A, and 3 milligrams of boron may help. Long-term zinc use can lead to copper depletion, so if you decide to take it, make sure to take 1.5 to 2 milligrams of copper every day too.

Some men have had success with 250-750 milligrams daily of Tribulus terrestis, a herb that can increase testosterone and free testosterone levels. According to Wikipedia, T. terrestris has been shown to enhance sexual behaviour in an animal model, but less so in human experiments. It appears to do so by stimulating androgen receptors in the brain. T. terrestris is now being promoted as a booster for the purpose of increasing sex drive. Its use for this purpose originated from a Bulgarian study conducted in the 1970s, which found effects on free testosterone and luteinizing hormone in men belonging to infertile couples.

Cabbage is filled with indole-3-carbinol (IC3), a phytochemical that increases your testosterone, according to a study at the Rockefeller University Hospital in New York. The study also found that when men were given IC3, their levels of the female hormone oestrogen reduced by 50 per cent. Optimising your Vitamin D levels by exposing the skin to sunlight for just 15-20 minutes can raise your testosterone levels by 120 per cent, says a report from Boston State Hospital in the US. Exposing a large amount of your skin until it turns the lightest shade of pink, as near to solar noon as possible, is typically necessary to achieve adequate vitamin D production. If sun exposure is not an option, a safe tanning bed (with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields) can be used. Alternatively a vitamin D3 supplement can be taken orally, but research suggests the average adult needs to take 8,000 IU's of vitamin D per day in order to elevate their levels above 40ng/ml, which is the absolute minimum for disease prevention.

An amino acid called L-arginine improves erectile dysfunction (ED), and is also useful for all sorts of vascular diseases since it dilates blood vessels and improves blood flow. There are two types of L-arginine -- "time release" and "regular". Time-release is preferable for urinary problems because, although it has a lower peak, it lasts longer. For men having difficulty urinating, Dr Wright generally recommends taking 3 g of L-arginine daily in addition to other nutrients and botanicals that help improve prostate health as mentioned above. You can find regular L-arginine at most natural food stores. However, time-release L-arginine (sold as a product called Perfusia) is available primarily through compounding pharmacies.

According to, research shows that a diet with less than 40 percent of energy as fat (and that mainly from animal sources, i.e. saturated) lead to a decrease in testosterone levels. This means not only mono- and polyunsaturated fats, like those found in avocados and nuts, but also saturated, as these are essential for building testosterone. He also states that Branched Chain Amino Acids [BCAAs] result in higher testosterone levels, particularly when taken along with resistance training. While BCAAs are available in supplement form, you'll find the highest concentrations of BCAAs like leucine in dairy products – especially quality cheeses and whey protein.

When to see your doctor

Symptoms of prostatism such as poor flow, getting up at night and sexual difficulties should always be discussed with your Doctor. When approaching middle age, it is always wise to take some time to assess your health and lifestyle habits, and male sexual health is an integral part of that assessment. Although the PSA has been overused, it remains a useful screening tool, and its measurement should be part of any man’s routine health check as he approaches middle or old age, along with blood sugar, blood pressure, weight, abdominal girth and lipogram. Approximately one in eight men older than age 50 has osteoporosis, a condition usually associated with post menopausal women, so take time to speak to your Doctor about your general health while it is still good, as a stitch in time may save nine!

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