Is There Such A Thing As "Man-o-pause"?

It seems everyone, everywhere is talking about perimenopause and menopause—that transitional time in a woman's life when there is a decline in hormone production by the ovaries. This decreased ovarian function can lead to some very specific and well-known symptoms, including hot flashes, night sweats, and low libido. Relief from many of these symptoms can often be found by taking or using certain hormones that have been declining, usually some combination of estrogen and progesterone.

But do men undergo any similar transition? As men age, is there a decline in male hormones—testosterone, mainly—that can cause similar recognizable and problematic symptoms? And can those symptoms be relieved by taking testosterone?

“Andropause” is a somewhat controversial term for an age-related decline in testosterone in men. Testosterone is usually high in male infants at birth, then declines during the first weeks of life. From age two until about age eight, testosterone remains low. During puberty, with the growth of the testicles, there is usually a dramatic rise in serum testosterone. Total testosterone peaks at age 19, and after the mid-30s, there is a gradual decline in testosterone of about 1% a year. It is not completely known whether the decline in testosterone is simply a result of aging or whether it decreases along with other factors that may accompany men's aging, such as obesity, diabetes, and other health issues.

Unlike the abrupt hormonal drop women experience in menopause, testosterone production in men declines gradually. Unless a man has consistently low testosterone levels—a total testosterone level under 300 ng/dL on two separate morning lab tests—along with symptoms associated with low testosterone, such as decreased libido, fewer morning erections, and erectile dysfunction, there is very little evidence that taking testosterone will help.

Many people believe that symptoms such as decreased energy and muscle mass, mood disturbances, weakness, and loss of body and facial hair are caused by low testosterone, but it is not clear that these symptoms are directly related.

Testosterone replacement has demonstrated some benefits for low sexual desire and erectile dysfunction in men who have been found to have low testosterone. However, medical societies do not recommend routinely prescribing testosterone to all men over 65 simply because their testosterone may have naturally declined with age. A low level is not necessarily the cause of their other symptoms.

Just as not all menopausal women should automatically receive hormone replacement, declining testosterone does not automatically mean every man should receive testosterone replacement. Men may suffer from mood changes, brain fog, poor sleep, and sexual dysfunction as they age, just as menopausal women may. In both situations, appropriately selected patients may derive meaningful benefits from a hormone plan by working with a physician with expertise in this area. In addition to appropriate hormone management, the best plan for men and women as they age will always include exercise, a healthy diet, good sleep habits, stress management, and social connection. Those things should never "pause."