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Understanding the ‘Male Menopause’

Author: Dr Oli Maunsell - Medical Director

Oct 17, 2023

Although the term ‘male menopause’ has gained traction in the media, it’s not accurate to compare the hormone changes experienced by the average male (a gradual reduction in testosterone levels), to the more dramatic changes experienced by woman during the menopause.

That said, the notion of a ‘male menopause’ or ‘andropause’ could help in raising awareness for the general health changes that can impact men as they age. Especially for the sizeable proportion of men that will experience lower than average drops in testosterone as they age.

How hormones change as men age

Although it’s important to note the differences between menopause and the male menopause, there are genuine health changes that impact men as they age. The primary hormone associated with sexual development, fertility and broader areas of health - testosterone - does start to decline naturally at around the age of 30 at a gradual rate of roughly 1% per year. For many men, they won’t feel any impact from this slow decline, but for others, testosterone levels can decline more rapidly and more significantly. This can cause hypogonadism otherwise know as low testosterone, and it’s known to be more common in men with diabetes or obesity.

How common is low testosterone in men?

For men over 45, it’s believed that up to 40% of men can suffer from low testosterone. This increases up to 50% for men suffering with diabetes. There’s also evidence of a longer term decline in average testosterone, with levels averaging 20% lower than they were 20 years ago. It’s speculated that a more sedentary lifestyle, poorer diet and pollution could be contributing to this.

In the UK there are also some differences in how the NHS diagnoses low testosterone vs how the British Society of Sexual Medicine assesses this, with the NHS focusing on more severe cases of low testosterone only.

How low testosterone can impact your health

The symptoms of low testosterone can be wide ranging, but typical symptoms include low energy, decreased sex drive, erectile dysfunction, reductions in muscle mass, mood changes and brain fog.

These could also be symptoms of a broader range of issues, related to both mental and physical health. Issues like poor sleep, sexual issues and low mood can be exacerbated by stress, anxiety and depression.

How low testosterone is diagnosed

Although some other tests exist, the most clinically reliable way to test for low testosterone is by conducting blood analysis. In addition to this, symptom questionnaires can be useful to get a broader picture of health and habits that might impact testosterone levels.

At Ted’s Health, we ask our patients to do two blood tests at least 4 weeks apart, between 7-11am. Testosterone levels below 12 (or below 14 if you are diabetic or pre-diabetic) may indicate low testosterone. In any event, our UK registered doctors will have a one-on-one call to discuss your results and and possible treatments.

Treatment options for low testosterone

Those suffering from low testosterone can benefit from Testosterone Replacement Therapy (TRT). Typically, treatment starts with a blood test to assess testosterone levels and check for any relevant, additional health issues; with any appropriate treatment being recommended by a doctor as required. The treatments available include gels that are applied to the skin, injections, with other treatments options such as tablets being developed. Alongside treatment for low testosterone, treatments for erectile dysfunction or low fertility might also be recommended.

It’s really important for clinicians to understand the health background of their patients as certain people might not be able to receive TRT, including those with:

  • Past history of breast cancer

  • Past history of liver tumours

  • Persistent high calcium levels

  • Current or active prostate cancer

People with significant liver or kidney disease may also need to be careful as TRT can cause fluid retention. TRT may also worsen epilepsy migraines and sleep apnoea.

Some medications may also interact with TRT such as:

  • Insulin: TRT may increase the effect of insulin

  • Blood thinners: TRT may interact with blood thinners to increase risk of bleeding

  • Steroids: TRT may affect the dose of steroids

Navigating the ‘male menopause’

Although the term ‘male menopoause’ may have its limitations and critics, there’s no doubt that men do face health challenges as a consequence of aging that can significantly impact quality of life.

An important initial step to navigating these changes is awareness, so speaking to our local GP or health professional is a key first step. There are also a range of privately available health testing services that can be useful to help us get a broader idea of our health.

There are also some sensible lifestyle changes that a wide spectrum of health professionals and organisations recommend, such as stopping smoking, reducing alcohol consumption and regular exercise.

Beyond physical health, it’s important to consider mental wellbeing, with many GP surgeries in the UK able to arrange appointments for patients with trained mental wellbeing specialists.

If you are worried about testosterone levels specifically, then Ted’s Health can help you, we offer a simple to do at home test that can give you a clear idea of your current testosterone levels.