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Male menopause: facts and myths

Healthy men, when they reach middle age, experience a sudden, dramatic fall in sex hormones equivalent. Picture: File

Healthy men, when they reach middle age, experience a sudden, dramatic fall in sex hormones equivalent. Picture: File

Published Jun 27, 2019


The term “male menopause” was coined in 1944 by researchers Carl Heller and Gordon Myers to describe a range of complaints that mirror the symptoms in menopausal women, including depression, anxiety, loss of libido, lack of energy and sometimes hot flushes.

The blame is usually placed squarely on falling levels of the male sex hormone testosterone. But male menopause, also known as andropause, is a not a medically recognised term.

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Furthermore, there is no evidence that healthy men, when they reach middle age, experience a sudden, dramatic fall in sex hormones equivalent to the one that women do.

The UK’s National Health Service (NHS) website says the term “male menopause” is misleading because “although testosterone levels fall as men age, the decline is steady at less than 2% a year from the age of 30 to 40 and this is unlikely to cause any problems in itself”.

But this has been fiercely debated and, as a result, men who say they are suffering can struggle to get treatment on the NHS.

“I have been listening to patients’ stories for the past 15 years and I am convinced that the male menopause is a genuine thing,” Dr Clive Morrison, a doctor from the Centre for Men’s Health in London, said.

“Most patients are not getting the treatment they need, which is very sad.”

And there is research to suggest that there really is something going on.

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A study conducted by the Centre for Men’s Health and University College Hospital, in London, of 2000 men with an average age of 54 who reported symptoms of the male menopause including loss of libido and depression, found that these symptoms improved after the men had testosterone replacement therapy - the male hormone testosterone given as a gel, cream, tablet or implant.

And that is despite the fact that 83% of those in the study - published in 2015 in the journal The Ageing Male - had testosterone levels that would have been considered in the normal range - that is, roughly between 10.4 and 41.6 nmol/* (nanomoles per litre of blood). This implies that testosterone deficiency in older men is much more common than screening methods suggest, possibly because different men need different levels of the hormone to feel “normal”.

There were some concerns about the study.

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Dr Richard Quinton, a consultant endocrinologist based at Newcastle University, said it was “unreliable and badly designed”, so its results should not be taken too seriously.

Frederick Wu, a professor of medicine and endocrinology at Manchester Royal Infirmary, cautioned against offering therapy to men who do not have proven testosterone deficiency.

“If testosterone levels are in the normal range, symptoms would not be caused by testosterone deficiency and there is no indication for testosterone replacement therapy, which will not only be ineffective but, if used in higher doses, can give rise to side-effects,” he said.

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Older men on long-term testosterone therapy could face a higher risk of cardiovascular problems such as heart attacks and strokes. Testosterone is known to increase the production of thromboxane, a compound that narrows blood vessels and may increase the risk of clots forming in arteries. A small number of men may develop breast swelling or tenderness, acne or swollen ankles.

Doctors can order blood tests to measure testosterone levels if they suspect there is a genuine medical problem - for example, late-onset hypogonadism, which is caused by a dramatic fall in circulating testosterone when the testes produce few or no hormones. It can occur in middle-aged men who are obese or have type 2 diabetes and is linked to high body fat.

Daily Mail

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