What Is Male Menopause?
Male menopause isn’t a clinical diagnosis, but it’s a term patients sometimes use to ask about symptoms that are common with low testosterone or hypogonadism. People with male reproductive organs will naturally see testosterone levels drop with age, but not everyone’s drops to the point where it is considered hypogonadism or needs treatment.
Male menopause is just one of many ways to describe a constellation of symptoms that older men can experience when their testosterone levels drop, says Ali Dabaja, MD, a urologist and the director of male reproductive and sexual medicine at Henry Ford Health in Detroit.
It can also sometimes be called andropause, age-related androgen decline, late onset hypogonadism, low testosterone, or testosterone deficiency, he explains.
Most people with male reproductive organs will still have testosterone levels within a normal range, but somewhere between 10 and 25 percent of men will develop low testosterone.
“A big misconception I see is that taking testosterone is always the answer, because that’s really not the case,” Dr. Debaja says. “Low testosterone doesn’t happen to everyone.”
Although there is a conceptual link to menopause in females, it’s important to note that this age-related hormonal change in men is very different from what happens in female menopause.
“People try to correlate it with female menopause where you have a sudden drop in female hormones and estrogen drops abruptly — but male menopause is not the same,” says Ramy Abou Ghayda, MD, MPH, an assistant professor of urology at University Hospitals and Case Western Reserve University in Cleveland.
“Male menopause” isn’t a clinical diagnosis, but low testosterone and hypogonadism are, Dabaja says.
Even though all men will biologically experience a decline in testosterone, not all men will experience the symptoms related to low testosterone that get referred to as “male menopause” — or require diagnosis or treatment.
Many men who start out with testosterone levels that are average or within the healthy range when they’re younger will still have normal levels as they get older, even as testosterone declines with age, Ghayda says.
“It’s the men who start out in the lower end of the normal range and then go through that steady decline of 1 percent a year as they age who can end up with such a substantial decline that they wind up with ‘male menopause,’” Ghayda says — or symptoms of age-related low testosterone that require treatment.
Doctors will rule out these things before considering a diagnosis of age-related low testosterone, or male menopause, Ghayda says.
Men can’t completely prevent male menopause because it’s an age-related process and it depends on how much testosterone they naturally produce. But they can take steps to potentially slow down how rapidly their testosterone levels decline over time, Ghayda says. “Anything that’s good for your overall health and well-being is also going to be good for your testosterone levels.”
Both these risk factors and aging can independently depress testosterone. That means for some men, losing weight or achieving healthy blood sugar levels might be enough to raise testosterone so that when they do start to lower naturally with age, they don’t dip so low that they cause symptoms, Ghayda says.
He advises everyone to focus on healthy eating (meaning load up on greens, and limit or avoid added sugar, trans fat, and processed food), focus on managing stress, getting enough sleep, and exercise (including muscle-building activities). He also suggests abstaining from smoking and limiting alcohol. “All these things can help prevent chronic diseases and also help with testosterone levels,” Ghayda says.
Remember that male menopause is not a medical diagnosis. So the diagnosis would be age-related low testosterone or hypogonadism, Dabaja says. This diagnosis is confirmed via blood tests that show someone has a testosterone deficiency and other symptoms stemming from age-related declines in this hormone.
Less straightforward is exactly what level of testosterone is low enough for a clinician to diagnose and treat low testosterone. Not all clinicians use the same cutoff point from blood test results to diagnose low testosterone or initiate treatment for the condition, Ghayda says.
It’s worth noting that when evaluating men for age-related low testosterone or male hypogonadism, clinicians assess both total testosterone and free or bioavailable testosterone levels, Ghayda says.
Total testosterone refers to all testosterone in circulation, including that bound to proteins like sex hormone-binding globulin (SHBG) and albumin, as well as unbound (free) testosterone, he explains. Only free testosterone and some of the testosterone that is loosely bound to albumin are biologically active, he says.
In men with obesity or other conditions associated with reduced SHBG levels, total testosterone levels may appear artificially low due to diminished SHBG-bound testosterone, he continues.
“However, free and bioavailable testosterone may remain within the normal range, reflecting an adequate androgenic effect,” he continues. “This discrepancy can lead to misdiagnosis if only total testosterone is assessed.”
Ghayda says he considers the type and severity of his patients' symptoms to decide whether a testosterone level in the low range warrants treatment. “These lab tests are just a starting point for deciding the diagnosis,” he says.
There’s no way to reverse low-testosterone. The good news is that if men have been correctly diagnosed and treated for age-related low testosterone, they can achieve meaningful improvements in their symptoms and quality of life, Ghayda says.
“Most men who meet the clinical definition of this diagnosis will go on testosterone replacement therapy for many years, or even for the rest of their lives, because their testosterone levels will go back down and their symptoms can return if they stop treatment,” Ghayda says.
Some men, however, may opt to stop treatment as their life circumstances change, Dabaja says.
“They usually stay on treatment as long as they feel as though symptoms would negatively impact their day-to-day life,” Dabaja says.
When patients have a proper diagnosis (based on lab tests and symptoms) of age-related low testosterone, the go-to treatment is usually testosterone replacement therapy.
Some men may also benefit from other medications or interventions to address some of their specific symptoms, Ghayda says.
For example, Ghayda says, men suffering from low libido might benefit from counseling with a sex therapist to identify other lifestyle or behavioral changes that might help, such as improving communication, scheduling intimacy, focusing on foreplay, or practicing sensate focus exercises, which shift the focus away from physical acts and emphasize emotional closeness.
A clinician might recommend that men experiencing low energy or mood swings see a psychologist or psychiatrist to identify and treat any mental health symptoms that can occur along with male menopause.
There are also some men who think they need testosterone because they’re having symptoms that sound like male menopause, but their lab tests come back showing their testosterone levels aren’t actually low, Ghayda says.
“For them, I won’t prescribe testosterone, but I will still look at whether they might benefit from medication for erectile dysfunction if that’s the issue, or medication to reduce hot flashes if that’s their complaint — or whatever else I can prescribe to target their specific symptoms,” Ghayda says.
Severely low testosterone levels, whether age-related or not, can lead to many clinical morbidities, Ghayda says. These include the following:
“This way they have an insurance policy if they still want to start testosterone,” he says.
Dabaja estimates that about a quarter to a third of men over 60 will experience symptoms from low testosterone, and the percentage might increase with age.
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