The concept of menopause is almost exclusively associated with women. When we mention this phenomenon, we refer to the female body. While it is widely known, there is also a lesser-known counterpart: men also experience a form of menopause, commonly known as andropause. In this blog, we aim to shed light on this hormonal decline in men by exploring its behavior, causes, symptoms, and diagnosis.
What is Andropause or Male Menopause?
Andropause, also referred to as male menopause or testosterone deficiency syndrome, is defined as the gradual decrease in testosterone production in men. Although the World Health Organization (WHO) does not formally use the term “andropause,” it acknowledges this process as a natural part of male reproductive aging.
As men age, testosterone production naturally declines, beginning around age 30. However, noticeable symptoms of andropause may not appear until their 40s or 50s, with considerable variation from one individual to another. A significant drop in testosterone levels often occurs after the age of 70, a much later onset compared to female menopause.
Several factors may accelerate the onset of andropause, including stress, depression, obesity, and chronic illnesses.
Differences Between Male and Female Menopause
As highlighted by the medical publication Reproducción Asistida ORG, andropause is often compared to female climacteric changes, though they are not the same. One of the key differences is that symptoms in men appear more gradually and subtly, such as mood changes.
Crucially, men do not lose fertility with andropause; it only decreases. Men are still capable of fathering children well into their 60s and beyond, which is not possible for women post-menopause. If fertility issues are suspected, it is advisable to consult a fertility clinic for a personalized evaluation.
Common Symptoms of Andropause
Andropause, or androgen deficiency in the aging male (ADAM), presents a range of physical, sexual, cognitive, and emotional symptoms that directly impact a man’s quality of life. Key symptoms include:
- Persistent fatigue: Testosterone supports energy metabolism and vitality. Its decline can cause low energy, apathy, and chronic fatigue.
- Low sex drive: Testosterone is crucial for libido. Its decline affects the hypothalamic-pituitary-gonadal axis. Clinical studies show over 70% of men with andropause report low libido.
- Erectile dysfunction: While vascular and neurological factors also play a role, testosterone significantly influences spontaneous morning and nighttime erections.
- Emotional changes: Testosterone affects brain receptors related to mood. A deficit can alter neurotransmitters like dopamine and serotonin, sometimes mimicking primary mood disorders.
- Loss of muscle mass and increased abdominal fat: Testosterone has an anabolic effect, promoting protein synthesis and regulating fat distribution. Its deficiency can lead to sarcopenia and increased visceral fat.
- Sleep disorders: Hormonal imbalances can disrupt circadian rhythms and deep sleep architecture, worsening fatigue and irritability.
- Memory and concentration problems: Testosterone contributes to cognitive processing and executive function.
A study by Castelo found that decreased erections, diminished libido, depression, and memory loss were the most commonly reported symptoms among men aware of male menopause.
Diagnosis of Andropause
The criteria for diagnosing andropause have been debated for decades. Although no universal clinical standard exists, Saint Louis University in Missouri developed a 10-question screening tool. A diagnosis is considered likely if the patient answers “yes” to questions 1 and 7, or to any three other questions.
| 1. Has your sex drive decreased? | SI | NO |
| 2. Do you feel a lack of energy? | SI | NO |
| 3. Have you experienced a decrease in strength or endurance? | SI | NO |
| 4. Have you lost height? | SI | NO |
| 5. Have you noticed a reduced enjoyment of life? | SI | NO |
| 6. Are you feeling sad or irritable? | SI | NO |
| 7. Are your erections less strong? | SI | NO |
| 8. Have you noticed a decline in your athletic ability? | SI | NO |
| 9. Do you fall asleep after dinner? | SI | NO |
| 10. Have you experienced a deterioration in work performance? | SI | NO |