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Male menopause: Myth or reality

Most of us have heard of menopause, the mid-life hormonal changes marking the end of a women’s menstrual cycle. But can men go through a ‘change of life’ too?

Both men and women go through natural hormonal changes over their lifetime. While women experience a relatively abrupt drop in oestrogen and progesterone levels during menopause, testosterone levels will generally peak in men when they’re in their 20s and gradually decline with age. Unlike women, men can continue to reproduce well into their senior years. This is where terms such as ‘male menopause’ and ‘manopause’ can be misleading. While menopause is a natural and inevitable process for ageing women, a reduction of testosterone production isn’t a seminal event and doesn’t necessarily happen to every ageing man.

So, what’s manopause and who gets it?

If a man’s testes aren’t producing enough testosterone for the body to function normally, this is known as manopause, andropause, testosterone deficiency or ‘low T’. Testosterone is one of the most important androgens (male sex hormones), as it is needed for normal reproductive function, overall good health, growth of strong bones and muscles and it affects mood and libido.

Chronic conditions, such as diabetes, high blood pressure or thyroid problems, and taking certain medications, such as glucocorticoids and other steroids, can all affect testosterone production. One of the clinical diagnoses of andropause is hypogonadism, a condition where the testicles don’t produce enough testosterone. The tricky thing about the low testosterone phenomenon is that, regardless of age, a man’s general health influences his testosterone levels. Being overweight, stressed or sleep deprived can cause low levels. Some doctors disagree that age is the primary cause of low T, calling it a myth. What we do know is that obesity appears to be the most significant health factor associated with lowering testosterone, more than the effects of ageing and other factors.

When to visit the doctor (the red flags)

• Reduced libido and sexual activity
• Decreased or absent early morning/ spontaneous erections
• Erectile dysfunction

Symptoms of low testosterone
• Low energy levels
• Depressed mood
• Decreased physical performance
• Reduced muscle bulk and strength
• Increased body mass index and body fat
• Sleep disturbance.

Is low testosterone preventable?

There are ways that men can alleviate symptoms of so-called manopause, adding to the debate that declining testosterone isn’t an inevitable, age-related ‘slow-down’, but is actually preventable, by way of some simple diet, exercise and lifestyle tweaks.

Exercise

While extreme endurance workouts, such as iron man and marathon training, have been shown to lower testosterone production, short, intense interval workouts, one-hour sessions of running or cycling or resistance weight training have all been shown to boost levels.

Consistency is key. Keep training sessions short but intense and keep them up for at least eight weeks. Heavy weight lifting, such as three to five repetitions with three minutes rest in between, can help the body release higher amounts of testosterone.

Body composition

Having a high body fat percentage can disrupt hormones such as testosterone and hamper your ability to gain muscle. Aim to decrease body fat and increase muscle mass through healthy diet and exercise. Waist circumference is a good belly fat indicator in men – aim for 102cm or less.

Sleep

Men who sleep less and have poor sleep quality are more likely to experience low testosterone levels, while sleeping longer has been found to improve levels. Aim for at least seven to eight hours a night. For better sleep quality, stick to caffeine-free drinks from midday onwards and minimise blue light from electronic devices at least one hour before sleep.

Stress

High levels of cortisol, a stress hormone, are associated with low testosterone. Meditation or progressive muscle relaxation can be a great stress-buster. It’s important to make time for yourself to relax and unwind each day, even a quick 20-minute walk at lunch or before or after work can make a big difference.

Diet

There isn’t enough evidence to suggest specific foods boost testosterone levels, but we know a nutritious, balanced diet is key to overall good health. Including whole foods (food recognisable in their natural state) in every meal and limiting highly processed and refined food and drinks can help lower energy intake and maintain a healthy weight. You can have too much of a good thing, so watching your portions is key.

Alcohol

Alcohol consumption directly reduces testosterone output. If you can’t quit alcohol altogether, try to cut back your intake and maintain a healthy diet and exercise routine to keep hormone levels balanced. Alcohol can have a cumulative effect on testosterone levels too, so try to have as many alcohol-free days as possible. The Ministry of Health recommends at least two alcohol-free days every week.

Can andropause or low testosterone be treated?

While there are treatments available for clinically low testosterone, testing and diagnosis can be tricky. Many of the symptoms can also be caused by other health issues and be experienced by men with normal testosterone levels. Hypogonadism can cause the clinical ‘red flag’ symptoms. In those cases, a referral to an endocrinologist (a specialist in hormone-related diseases) can confirm the diagnosis and explore treatment options, which can include testosterone replacement therapy.

Take home message

While conditions such as hypogonadism are very real, it’s clear androgen deficiency can be influenced by ill health and obesity and there’s evidence to suggest it could even be preventable. Although men do experience a natural decline in testosterone as they age, this alone shouldn’t be enough to bring on manopausal symptoms. Being fit and active, eating well, reducing stress and, most importantly, watching weight will help keep hormone levels healthy and thriving at any age.

Unless symptoms are showing, testosterone levels aren’t necessarily something to focus on, but are a good marker for men’s health in general. It’s also good to remember, doctors don’t bite – if you’re experiencing symptoms, have a chat to your GP about possible causes and remedies.

First published: Nov 2018



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