DoctorSpeak: All about male menopause & its effects

IT professional Aditya (48) had been experiencing extreme fatigue, declining energy levels, stress, decreased libido and erectile dysfunction for some months now. He had also gained weight, especially around the abdomen, despite a ‘clean diet’. On his doctor’s recommendation, clinical investigations showed a drop in his testosterone levels to 280 ng/dl (normal 300-1000ng/dl). His diagnosis — andropause — also known as the late onset of hypogonadism. Chronic stress raises cortisol levels which can cause both central obesity as well as the onset of andropause.

Like women, as men age, they, too, experience a gradual decline in hormone levels, particularly testosterone. This natural process is called andropause, often referred to as the male menopause. While not as well-known as menopause, andropause can significantly impact a man’s physical and emotional well-being.

Andropause refers to the age-related decline in testosterone levels and the accompanying symptoms experienced by men. Like menopause, andropause is also a gradual decline in hormone production in males, usually occurring in middle-aged or older men, typically starting in their 40s or 50s, although the onset and severity can vary.

Symptoms

— Decreased energy, fatigue, sleep disturbance: Most men report feeling tired even after adequate rest.

— Sexual changes: Many feel a decline in libido, some may experience erectile dysfunction, decrease in sexual spontaneity and a longer recovery time between sexual encounters.

— Mood changes: It can cause mood swings, irritability, anxiety, even depression in some cases, due to hormonal fluctuations and the inability to cope with ageing concerns.

— Muscle and bone changes: Testosterone plays a crucial role in maintaining muscle mass and bone density. During andropause, muscle mass, strength and bone density may decrease, causing increasing frailty, raising the risk of osteoporosis.

— Changes in body composition: It can lead to an increase in body fat, particularly around the abdomen and may cause a decrease in overall physical fitness and self-esteem.

— Insomnia, hot flashes, breast tenderness: Though not all but some men may experience sleep disturbances/insomnia, even hot flashes, breast tenderness, or concentration issues.

The primary reason is the age-related decline in testosterone production. Testosterone levels typically decrease by about 1 per cent/per year after 30.

Vikram (52), a software architect, recently sought consultation following complaints of ‘excessive soreness’ after weekly football games, persistent lower back pain, loss of physical stamina, strength and muscle tone, constant fatigue despite regular exercise and sufficient sleep. His diagnosis revealed borderline low testosterone and extreme vitamin D deficiency. In Indian men, low vitamin D levels often compounds andropause symptoms.

Other factors that contribute to andropause’s onset and progression:

— Unhealthy lifestyle: A poor diet, lack of exercise, excessive alcohol consumption and smoking, can speed up the decline in testosterone levels and exacerbate the symptoms.

— Chronic health conditions: Obesity, diabetes, high BP and heart disease, can also affect hormone production.

— Medications: Drugs like antidepressants, corticosteroids and opioids can interfere with testosterone production. Chemo or radiation therapy for cancer can also impact hormone levels.

— Psychological factors: Stress, depression and anxiety have a reciprocal relationship with andropause. Hormonal changes can contribute to emotional disturbances, while emotional well-being can also influence hormone regulation.

Diagnosis & treatment

If any middle-aged man experiences any of these symptoms, a simple blood test (on the advice of a urologist/andrologist or an endocrinologist) can check testosterone levels. Most specialists usually recommend:

— Hormone replacement therapy (HRT): In severe cases, testosterone replacement therapy (TRT) may be recommended. But it should always be taken under expert guidance because of its potential side-effects.

— Lifestyle modifications: Regular exercise, a balanced diet, stress reduction techniques and adequate sleep can help improve energy and significantly reduce symptoms.

— Psychological support: Counselling may be beneficial for those dealing with emotional challenges. Addressing the root cause and learning the coping mechanisms can help.

— Symptoms-based medicines: The doctor may prescribe some drugs to address erectile dysfunction, or extreme anxiety.

Andropause is a natural process that many men experience as they age. There is not much awareness about andropause and it is often confused with depression, diabetes, hypothyroidism, nutritional deficiencies (vitamins D and B12), which can cause a delay in diagnosis. Recognising and understanding the symptoms can help men seek timely and appropriate medical support and explore suitable treatment to live a healthy life as they age.

— The writer is a gynaecologist and infertility specialist, Cloudnine Hospital, Chandigarh

FACT-CHECK

Globally, strictly defined late-onset hypogonadism (low testosterone plus clear symptoms) affects only 2-6 per cent of men aged 40-79. Broader low-testosterone levels (without symptoms) are more common: 20-30 per cent of men over 60-70 years have low readings. Testosterone falls steadily, but most men adapt or have no major issues. Symptomatic cases rise with age, obesity, diabetes, and chronic illness.

Indian studies report higher symptom rates than strict Western definitions. In a 2009 study of healthy Indian men (hospital staff, age 40-60+), 67.5 per cent reported symptoms, but only 26-33 per cent had both symptoms pluse confirmed low free/total testosterone. Other Indian research found symptomatic andropause in 40-71 per cent of men over 40, with confirmed low testosterone in 25-40 per cent of cases. Awareness is very low as only 2-17 per cent men had even heard the term ‘andropause.’ Rates are higher in men with diabetes, obesity, or sedentary lifestyles.