You may see it listed by any number of names, including hypogonadism, late-onset hypogonadism (LOH), low testosterone, Low T, testosterone deficiency (TD), androgen deficiency, male menopause, or andropause. No matter the name, andropause and low testosterone are the same – and something every man should understand.
Hormone replacement therapy (HRT) has long been the standard for the treatment of female menopause. Because men also undergo changes in hormone production as they age, they, too, can suffer from symptoms of declining hormone levels. While many women can also benefit from testosterone replacement therapy (TRT) if they have low testosterone levels, this report focuses attention solely on andropause, testosterone deficiency, and hypogonadism in males.
In this review of male andropause and low testosterone, we will discuss the following topics:
- What is andropause and why does it happen
- Changes in testosterone levels over the years
- Signs and symptoms of andropause
- Diagnosing and treating male menopause
- Testosterone replacement in men with andropause
Male menopause goes by many names, including andropause and low testosterone.
What Is Andropause and Why Does It Happen?
Andropause is a term that means a pause or decline in the production of androgen hormones such as testosterone. As a man ages, many hormone levels in the body begin to change – most notably, testosterone. Andropause is a significant decline in testosterone production that leads to symptoms associated with what is most commonly referred to as Low T.
Of course, if you look around at a room of sixty-year-old men, you will likely notice some who exhibit the classic symptoms of low testosterone and others who show no signs of slowing down or aging.
Why does andropause happen to some men but not all?
Many factors contribute to the development of andropause and low testosterone. For some men, it is genetic. Their fathers, grandfathers, and great grandfathers may have all suffered from the same early or rapid onset of testosterone decline. Genetics are not definitive – a man can often take steps to slow the natural decrease of testosterone.
Other contributing factors to testosterone decline include:
- Lack of sleep – that is when much of testosterone production occurs
- Poor diet – food choices can influence hormone production
- Weight gain – men who are overweight typically have lower testosterone levels
- High stress – increased cortisol production inhibits testosterone secretion
- Tumors or cancer – testicular, pituitary, or hypothalamic cancer or tumors can lead to reduced testosterone production, as can their treatment
- Lifestyle habits – smoking and alcohol and drug abuse can lower testosterone levels
The most common cause of andropause and low testosterone is age-related decline.
Changes In Testosterone Over the Years
Testosterone levels taper off after puberty and start to decline by the time most men reach their late twenties. After that, the decrease can range from one to two percent each year. For many males dealing with low testosterone, andropause symptoms do not appear until many years or decades later. Middle age is the time when the signs of andropause are most apparent.
How can andropause affect testosterone?
A man who is at the lower end of testosterone decline will have about seventy percent as much testosterone in his bloodstream at age 60 as he did at age 30. However, someone who loses up to two percent each year will be left with only forty percent of his testosterone by age 60. Those numbers are staggering, and the effects can be highly detrimental to a person’s health and quality of life.
When you think about all the uses of testosterone in the body, such as red blood cell production, sperm cell maturation, libido, metabolism regulation, muscle and bone-building properties, and mental stimulation, you can see how andropause and low testosterone can cause significant changes in a man’s well-being.
Testosterone levels decline at a rate of about one to two percent each year, starting in a man’s late twenties.
Signs and Symptoms of Andropause
Although the medical condition known as andropause is a sign of low testosterone levels, the symptoms are the same. Whatever you call it, andropause or hypogonadism can lead to significant health issues for a man.
Warning signs of andropause and low testosterone can manifest as any of the following health conditions that increase in risk when there is not enough testosterone in the bloodstream:
- Cardiovascular disease
- Type 2 diabetes
Depression is not just a symptom of low testosterone; it is also a clinically diagnosed condition that can arise when hormone levels are out of balance.
The most common symptoms of male andropause include:
- Insomnia and other sleep disturbances
- Lack of energy and stamina, fatigue, lethargy
- Low libido
- Erectile dysfunction including loss of morning erections
- Urinary problems due to prostate enlargement
- Increased body fat
- Decreased muscle mass
- Poor workout results
- Joint pains
- Height shrinkage and decreased bone density
- Breast enlargement, swelling, or tenderness
- Thinning or balding hair
- Hot flashes
- Mood swings
- Increased stress or anxiety
- Social isolation
- Lack of interest, decreased drive, reduced productivity
- Poor focus
- Impaired cognitive functions
You may also have high LDL and total cholesterol, triglyceride, glucose, and blood pressure levels if you have andropause.
Andropause and low testosterone manifest in many recognizable symptoms.
Diagnosing and Treating Male Menopause
Diagnosis of andropause and low testosterone encompasses two areas: symptoms and serum testosterone levels. Both must be present to receive treatment for Low T.
Many males do just fine with very low levels of testosterone as the body is designed to adjust to these changes as we age. Some men may find out during routine lab tests that they have low testosterone levels even though they exhibit no signs of andropause. When that is the case, no action is necessary.
Other men report many of the listed symptoms of low testosterone, yet their blood test levels are still in the normal range – although typically at the lower end of the scale. In this situation, the hormone specialist will use his or her judgment to determine if andropause treatment & testosterone replacement is necessary. The majority of men in this situation will respond favorably to testosterone therapy.
In addition to undergoing consultation and blood analysis, each man concerned about low testosterone will also receive a physical examination and complete a medical history questionnaire. The hormone specialist will want a full understanding of any current or past health issues, medications, treatments, and even over-the-counter supplements that a person has or still uses. Any of these items could relate to changes in testosterone levels.
Diagnosis of andropause and low testosterone consists of a review of symptoms, blood tests, and physical exam findings.
Testosterone Replacement in Men with Andropause
Andropause is one of the easiest forms of hormone deficiency to treat. Doctors have prescribed andropause testosterone replacement therapy for over 70 years with exceptional results.
Today, there are more options than ever before for the treatment of low testosterone levels in men, including:
- Testosterone injections
- Transdermal skin patches
- Transdermal testosterone gel
- Nasal gel
- Implantable testosterone pellets
- Transbuccal adhesive tablets
There are pros and cons to each type of treatment. Testosterone injections such as testosterone cypionate and testosterone enanthate are the gold standard – they offer the best absorption into the bloodstream, provide long-lasting effects, and have the lowest cost per month. Best of all, most men only have to inject testosterone once a week or once every other week.
Transdermal skin patches and gel are daily treatments that are easy to use but increase the risk of skin rashes and cross-contamination to others. Since there is no way of knowing in advance how well the body will absorb the testosterone through the skin, dosage may be a hit or miss. The costs are also considerably higher.
Nasal gel requires a slightly messy application three times per day in each nostril, making this costly treatment less desirable for many men.
Implantable pellets are an out-patient surgical procedure that costs significantly more and carries specific risks. If the treatment does not work or there are side effects, removing the pellets is difficult. Also, if the pellets work their way out of the skin, that could decrease the results and lead to further costs for reinsertion.
Finally, transbuccal adhesive tablets that stick to the gums can lead to oral sensitivity, pain, and bitter taste. There is a slight risk of liver toxicity if the tablets are accidentally swallowed. This option is also higher in cost than testosterone injections.
The best testosterone injection on the market for andropause at this time is testosterone cypionate, followed closely by testosterone enanthate.
- US National Library of Medicine National Institutes of Health: Andropause – Current Concepts
- US National Library of Medicine National Institutes of Health: Testosterone Replacement in Men with Andropause
- MayoClinic: Male menopause – Myth or reality?
- HealthLine: What Is Male Menopause?
- HealthLine: Warning Signs of Male Menopause – Are You at Risk?