Andropause: Is male menopause actually real?

Menopause has often been viewed as an endless source of humour down the pub when blokes of a certain age get together. But did you know that there’s also a male version of menopause?

Often jokingly described as “manopause”, this isn’t a myth. Men go through a similar middle-aged process to women, where significant hormonal changes lead to decreases in testosterone from about the age of 35 [1].

So, what actually is andropause, what does it mean for you, and how do you know if you’re going through it now?

What is andropause?

Andropause is a hormonal shift in men that leads to a decrease in testosterone levels. According to Harvard University, testosterone levels decline by roughly 1.6% per year. Of course, this could be lower or higher, depending on the person [2].

The word comes from the Greek “Andras”, meaning male, and “pause”, meaning to stop something [3]. Although all women will eventually go through the menopause, andropause isn’t a guarantee. Some men don’t experience what’s known clinically as Androgen Deficiency in Aging Men (ADAM), or late-onset hypogonadism [4].

While it might sound concerning, it’s usually nothing to worry about. Age-related testosterone is entirely normal and is why a middle-aged bloke doesn’t have the same sex drive as a horny teenager.

Low testosterone levels and late-onset hypogonadism

Testosterone is the primary male sex hormone. However, the function and purpose of this male hormone extend far beyond how often you feel the need to lock yourself away in your bedroom. Your testosterone is responsible for [5]:

• Physical Development – Facial hair, body hair, and the enlargement of the penis, prostate, and testicles.
• Musculoskeletal Health – Supports the growth and repair of muscle mass, as well as maintains your bone density and overall strength.
• Sexual Function – It controls your sex drive and also supports the body in producing sperm.
• Health and Well-Being – There’s growing evidence that testosterone supports everything from cognitive function and red blood cell synthesis to energy levels and mood regulation.

That’s why late-onset hypogonadism, or getting a diagnosis of low T, can present such a problem in middle-aged men and up. It’s estimated that the condition afflicts between two and five out of every 100 Aussie men [6].

Other studies from around the world show that the rate rises significantly with age, with fewer than 1% of men under 60 having the condition, increasing to 3.2% between 60 and 69, and further to 5.1% between 70 and 79 [7].

Is andropause the same as menopause?

In short, no. Andropause isn’t the same as the female menopause, which is why some clinicians have argued against referring to it as just the male version of menopause.

While both genders experience a decrease in their primary sex hormones, there are significant differences between them. For one, all women will eventually become infertile due to the menopause, whereas the same cannot be said for men. 

Likewise, andropause is gradual, whereas the menopause is extremely quick and sudden, hence the array of hot-flash jokes. The big difference is that not every man will experience andropause, but an age-related decline in testosterone is normal.

According to an older study, it’s estimated that by the age of 75, a man will have lost about 30% of their age 25 testosterone level [8].

What are the symptoms of andropause?

Andropause doesn’t kick in all at once. Most symptoms you’ll likely only notice over many years, if at all. It’s also vital to remember that symptoms can fall into many categories and may actually have nothing to do with andropause, in your case anyway.

People often think testosterone decline is purely an age thing, but only about 2% of cases are caused by age alone [9].

On a side note, if you’re worried about any andropause symptoms, you should contact your doctor and book an appointment to get their recommendations for treatments, including lifestyle changes and well-being-related options like Pilot’s Testosterone Support.

Physical changes

• Reduced muscle mass
• Reduced physical strength
• Decreased bone mineral density
• Weight gain, including fat redistribution throughout the body
• Constant tiredness
• Slowing of beard growth
• Decrease in height
• Loss of body hair

Sexual changes

• Lack of sexual desire and interest
• Difficulty achieving and holding an erection
• Morning wood becomes less common
• Lower sexual satisfaction

Emotional and cognitive changes

• Frequent mood swings
• Brain fog and trouble concentrating
• Lapses in your short-term memory
• Sensations similar to hot flashes and night sweats
• Loss of self-confidence
• Decreased motivation and self-drive

What causes andropause?

Andropause is caused by a gradual decline in testosterone levels, which can result in some or all of the bothersome symptoms described above [10].

Natural ageing is the main cause of lower testosterone levels. Very few men will reach middle age without losing a step compared to their teenage selves. Other factors can also impact whether you end up experiencing andropause because no one factor dictates testosterone levels exclusively.

Lifestyle factors are well-known for triggering hormonal imbalances, including decreased testosterone, with obesity, smoking, and excessive alcohol drinking often cited [11].

How is andropause diagnosed?

No simple test exists for diagnosing whether you’re a victim of the male menopause. The Royal Australian College of General Practitioners (RACGP) says it should be diagnosed only when there are consistent symptoms, and only after repeated blood tests and a physical examination [12].

The point isn’t to keep the numbers down but to stop the number of misdiagnoses. Andropause symptoms are so general and non-specific that it’s important to rule out other issues, which could be as simple as chronic stress or poor sleep.

In practice, once you book an appointment with your GP, you’ll usually go through the following process:

1. Clinical Assessment – You’ll have a meeting with your doc to discuss your medical and lifestyle history.
2. Physical Exam – The next step is to check for any physical signs of a testosterone deficiency, such as measuring your height and weight or checking for breast development or a loss of body hair.
3. Blood Tests – You’ll also receive a blood test to confirm that you’ve got low testosterone levels. These are conducted in the morning after fasting, when testosterone peaks due to your circadian rhythm [13]. Any deficiency will need to be confirmed with a separate test on a different day.

Note that depending on the outcome, your doctor might conduct extra tests to rule out any other medical conditions, including chronic diseases. They might analyse other hormones or check your iron levels. Sometimes, you might even get a genetic test to identify any underlying causes that could be causing problems in your life.

Managing the symptoms of andropause

Going straight for full-scale prescription-based paths usually isn’t the first option in Australia. Many GPs will often begin with recommending lifestyle changes, unless you’ve got critically low T levels.

Typically, Australia has been quite conservative with prescribing testosterone therapies due to big jumps in the past. Between 2007 and 2011 alone, the supply of subsidised testosterone, as part of prescription treatments like testosterone replacement therapy, actually doubled [14].

Examples of lifestyle changes your doctor might suggest for your overall health as part of a bespoke treatment plan include [15]:

• Resistance training, including lifting weights, to stimulate testosterone production naturally
• Making a concerted effort to lose weight and achieve a better body composition
• Healthy eating to rebalance your hormones and support your weight loss goals
• Getting more sleep to help keep your natural hormone cycle in check
• Reducing the stress factors in your life to combat cortisol
• Limiting how much you drink and smoke

These are also the lifestyle factors that go a long way to supporting healthy ageing in every bloke. It’s just all about living a healthier lifestyle that supports your mind and body as you move through every phase of your life.

When to speak to a doctor about andropause and hormone levels

Where do you draw the line between what’s just a natural part of getting older and something that might be a problem?

Generally, the rule is that if any andropause symptoms are persistently affecting your life, sleep, work, and relationships, it’s time to make an appointment with your doctor. Examples might include a noticeable decline in your sex drive, erectile dysfunction, increased body fat, chronic fatigue, or unusual changes in your mood.

It doesn’t mean anything is necessarily wrong, but it’s a good idea to talk to your doctor just to be on the safe side. They can perform a variety of tests and help ease any concerns you might have.

If there are any problems, they might be able to recommend different options to make managing symptoms easier, including changes to your diet, exercise programs, or clinician-led treatments for specific issues like Pilot’s ED treatment.

With that in mind, if you’re worried about andropause, make an appointment with your GP now.

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