What is Andropause?
Andropause is a condition affecting men which is the result of lowered testosterone levels. It is also known as late onset hypogonadism (LOH).
Andropause is more likely to occur in ageing men. The condition is typically related to the natural decline of testosterone over a man’s lifespan.
However, not all men with decreasing levels of testosterone will display symptoms of andropause. (1,2)
Testosterone is a hormone produced by the male reproductive system. It is primarily made in the testes.
This hormone is essential towards developing and maintaining male physical characteristics. These include voice pitch, muscle growth, and many more typical traits associated with the male sex. (3)
Andropause is occasionally referred to as “male menopause”. Unlike the female condition, hormonal decline (in this case testosterone) is gradual rather than rapid.
Diseases such as obesity can contribute to lower testosterone levels. Certain medications and chronic stress can also be partly responsible. (4)
Symptoms of andropause can include the following:
Andropause can result in chronic fatigue. You may feel tired even after sleeping or resting.
Testosterone deficiency can also disturb your sleep patterns which can worsen energy levels even further.
One of the classic signs of andropause is a loss of libido. This typically manifests as a decreased interest in sex. Sexual performance can also become impaired.
Decreased Morning Erections
A man with andropause can notice a decrease in morning erections. If an erection occurs, it may be weaker than usual. (5)
Erectile dysfunction is any issue relating to sustaining an erection. You may find it difficult to get an erection at all. Although this symptom is more common in older men, it is not a normal consequence of aging. (6)
This symptom often accompanies the onset of andropause. (7)
Lowered testosterone levels can provoke mood changes. You might notice you are more irritated than usual or get angry easily.
Negative thinking and depression can eventually manifest in some men.
Muscle Loss and Fat Gain
Andropause can result in physical changes to your body. Your muscles might not be as firm as they used to be or they decrease in size.
Consequently, you may notice a loss of strength and you can also gain fat around your abdomen. (8)
Reduced Physical Capabilities
Your physical abilities can decrease due to andropause. This can manifest as being unable to do activities that require intense exertion. (9)
Andropause can result in hot flashes. These are bouts of excessive sweating that are not related to the temperature around you. (10)
Testosterone levels are naturally higher in men than in women. Even when a boy is still inside the womb, this hormone starts the development of male reproductive organs. (11)
Andropause is characterized by a slow progression. Symptoms do not appear immediately, and can be hard to associate with the disorder.
The condition is linked to decreasing testosterone due to age and related complications. The average healthy male will progress through the following stages: (12)
At pre-puberty, a boy has not yet begun to sexually mature.
At this stage, both mental and physical changes begin to take place.
Testosterone is produced from the testes. This causes genital development, deepening voice and the appearance of facial hair.
Boys begin to develop a libido and an interest in sex. Testosterone also promotes muscle development and growth. (13)
Body odor, acne and mood swings are also common during puberty. Males typically begin puberty between the ages of 10 and 15 years old. (14)
Testosterone levels rise steadily during puberty. They typically reach their peak around age 19. (15)
Complete physical development is reached between two and five years after puberty begins.
Testosterone plays a role in maintaining strong bones and muscles, even after puberty. It also helps to enhance sex drive. (16)
Height, voice pitch and other physical aspects stabilize and remain constant. (17)
From ages 30 to 40 years old, testosterone levels will begin to steadily decrease. If you develop a chronic illness, your risk of testosterone deficiency will increase.
Traumatic injuries, health crises, and certain medications are also associated with lowered testosterone. (18)
Elderly men have a higher prevalence of andropause. A study revealed approximately 18 percent of men over age 70 exhibited symptoms of the disorder. (19)
If you present with symptoms of andropause, your doctor will rule out other possible causes.
Your doctor will also review your medical history. Certain medications, such as antidepressants and opioids, can result in similar symptoms to andropause. (20)
You may be administered the Androgen Deficiency in the Ageing Male questionnaire (ADAM). This is a form specifically designed to measure androgen (sex hormone) deficiency in older men.
The questionnaire asks you to rate certain aspects of your health and wellbeing. These include your libido, erections, energy levels and mood.
Your answers can help your doctor better understand your symptoms and how they affect your life. (21)
To diagnose andropause, three criteria must be met. These include: erectile dysfunction, loss of libido and lack of morning erections. (22)
The next step is to test your levels of testosterone through a blood test. Testosterone levels can fluctuate throughout the day.
Your doctor will likely perform the blood test earlier in the day to get the most accurate reading. This is because testosterone levels can decline later in the afternoon. (23)
If your testosterone level is over 350 ng/dL, it is within the lower-normal range for young men. Medical treatment will likely not be recommended.
However, if your levels are less than 230 ng/dL, you will be put on a treatment plan. Treatment for andropause aims to restore testosterone levels and alleviate symptoms. (24)
The treatments for andropause can include the following options:
Diabetes and obesity are two health conditions that are linked to testosterone deficiency. Improving your lifestyle can help reduce negative effects from these diseases. (25)
Excessive alcohol consumption or an illness can also provoke low levels of testosterone. In turn, this can worsen symptoms of andropause. (26)
A nutritious diet and regular exercise are also important to improve symptoms. You should try to avoid poor habits such as smoking and reduce stress if possible. (27)
Testosterone Replacement Therapy (TRT)
Testosterone replacement therapy involves taking doses of testosterone to restore low levels of the hormone.
TRT aims to alleviate symptoms and repair any physical issues caused by andropause.
The dosage of testosterone varies depending on each individual case.
Testosterone is available in a number of forms. It can be injected, taken as a tablet, or applied as a gel or patch.
Gels and patches that are transdermal (skin-penetrating) are easy to apply. They provide stable levels of testosterone over time.
Certain patches are designed to be applied to the scrotum. However, these patches can cause irritation in some men and may not adhere correctly to the scrotum.
Injections can cause intense feelings of euphoria in some men. If the effects of the injection wear off before the next dose, the symptoms of andropause can reappear.
However, testosterone injections tend to be more cost effective. It is also easier to alter the dosage.
Nonetheless, gels are the most preferred form of TRT. They are simple to use, despite being more costly than injections.
This therapy can decrease fat you have gained as a result of andropause. TRT can help restore muscle mass lost as a result of the disorder.
Patients with andropause on TRT generally report feeling better overall. Sexual function (i.e. libido) can also dramatically improve with treatment.
Various clinical studies have established TRT is a safe therapy for most men. Your doctor will decide which is the best testosterone treatment option is for you. (28)
What is andropause? Andropause is a condition that affects ageing men as a result of declining levels of testosterone.
What are the signs of andropause? The signs of andropause can include fatigue, low libido, erectile dysfunction and mood changes. You can also experience hot flashes, reduced physical abilities, muscle loss and fat gain.
How do you develop andropause? Andropause develops when testosterone levels decline.
What is the best treatment for andropause? The best treatment for andropause is testosterone replacement therapy (TRT). Your doctor may also recommend making healthy changes to your lifestyle.
What are the long term complications of andropause? If untreated, the symptoms of andropause can impair your quality of life. Loss of libido, erectile dysfunction and mood changes can be unpleasant to live with. Physical changes, such as loss of muscle mass and fatigue can interfere with daily activities.
Is andropause considered a disability? It is not likely that you would be eligible for disability with andropause. The condition does not impact your ability to work or directly result in death. (29)
Is andropause life threatening? Andropause is not life threatening in itself. However, the condition is associated with a higher risk of mortality, particularly from cardiovascular conditions. (30)
If you are exhibiting signs of andropause, do not dismiss them. Erectile dysfunction, fatigue and other symptoms of the disorder are not a normal aspect of getting older.
Treatment can significantly improve your quality of life. A healthier lifestyle can also contribute to better management of the disorder. (31)