Andropause – and the hormones that matter to men.

The term andropause – otherwise referred to as male menopause and ‘Low T’ (testosterone) is a natural age related condition that some men experience. The andropause transition is attributed to a steady and progressive loss of testicular function that is associated with ageing. Its meaning is derived from the Greek ‘andro’ meaning male, and ‘pause’ to stop.

What are androgens?

The symptoms of andropause occur through a lowering in the body’s production of testicular androgens in middle-aged men from around the age of forty. Androgens are a collection of sex hormones that provide men with their male characteristics. These hormones are crucial for male sexual and reproductive function. The andropause transition is also known by the acronym ‘ADAM’ (androgen decline in the ageing male). Lowered production of the major sex hormone ‘testosterone’ is the main factor that influences andropause.

Symptoms of andropause

The most common symptom of andropause is fatigue, especially in the morning. Other symptoms include, lack of motivation, lowered sperm production, body composition changes, erectile problems, lack of libido, sleep disruption, impaired memory, difficulty concentrating, hot flushes, irritability and mood swings. A diminished ability to play sports is among other symptoms of andropause.

Is andropause in men similar to menopause in women?

Andropause shares some characteristics with menopause. The similarities are due to the relationship between women’s ovaries, estrogen, the brain and the pituitary (a pea-sized structure at the base of the brain critical to hormones) to the male relationship with testis, testosterone, the brain and the pituitary. A major difference, however, is that not all men experience andropause. Whereas menopause in women is universal and expected, with the shutting down of hormones at around age 50 being a predictable event.

Testosterone and estrogen in men

Testosterone is produced in the testicles. As men age their testes stop working as well, and over time testosterone levels decrease. Testosterone levels reduce by around 1% each year from the forties and fifties. By their mid-fifties some 30% of men experience andropause (Balasubramanian et al 2012; Matsumoto,1993). During this period of testosterone decline the hormone levels of estrogen increase in men by almost 50%, drastically altering their hormone balance.

Estrogen plays a significant role in men’s health i.e bone mass and prevention of fractures. However, high estrogen levels may also contribute to prostate cancer and heart disease as well as gynecomastia (enlarged breasts). As men get older estrogen competes with the masculinizing effects of testosterone. Too little estrogen can predispose men to osteoporosis and lead to bone fractures.

Slightly elevated levels of estrogen can increase the risk of stroke and coronary artery disease. Men with higher blood estrogen levels may also be at risk for enlarged prostate or prostate cancer. This risk increases if men have low free testosterone blood levels.

Younger men and low testosterone

Although some men retain normal levels of testosterone into their eighties, others experience a severe drop at a much earlier age. There are an increasing number of younger men, some only in their twenties having low testosterone. Among reasons for premature low levels of testosterone, are factors such as high levels of stress, exposure to environmental toxins and alcohol use.

Testosterone for all-round physical and mental health

Optimal testosterone levels are needed for good function of the heart, blood vessels, brain, skeleton, blood, genitourinary tract, skin and almost every other body system. In particular, the brain is rich in receptors for testosterone. A normal testosterone level is protective against Alzheimer’s dementia, symptoms of Parkinson’s disease, and cognitive or mental decline. Testosterone improves mental sharpness, concentration, and memory. Testosterone also improves flexibility, mobility, balance, and coordination

Low testosterone and diabetes

Men with diabetes have far less testosterone than men without the disease. Studies have found that the pituitary glands of men with diabetes produce insufficient stimulating (luteinizing) hormones that trigger the production of testosterone in the testes. Conversely, higher testosterone levels can significantly decrease the risk of type 2 diabetes
(Yao et al, 2018).

What are the risks of ignoring andropause?

Since andropause occurs at a time when men begin to question their direction in life and past accomplishments, it is easily overlooked as simply a ‘mid-life crisis’. However, if ignored the symptoms of andropause can result in a gradual deterioration in health.
This can include an increased distribution of fat, loss of muscle and bone mass (osteoporosis) and reduced height. In turn, this can lead to frailty and premature ageing.

Hormone Therapy (prescribed medication)

Treatment for andropause involves the correction of nutritional and hormonal deficiencies. Hormone therapy for declining levels of testosterone may be recommended. This introduces hormones into the body to counteract hormonal imbalance and can be very effective (although it does help some men, it also carries risks, and may not always improve the symptoms of andropause).

Younger men that have symptoms of andropause often find that their testosterone level is in the normal range – but discover that it is at the bottom of the normal range. In these scenarios, men who have hormone therapy find that their energy levels are restored when their testosterone levels increase to the upper range. It is uncertain whether hormone therapy can assist healthy older men whose decline in testosterone is due to ageing. Your Doctor can discuss the benefits and risks of hormone therapy and whether it is an option for you.

There are a wide variety of ways in which testosterone treatment can be administered.
They include oral capsules, sublingual lozenges, patches, injections, implantable pellets, creams and gels. These can all be quite effective and have minimal side effects. However, andropause is often manageable without the need for testosterone therapy.

Self-help in overcoming the symptoms of andropause

Lose weight

A reduction in waist circumference is one of the most modifiable risk factors for testosterone deficiency. A man’s Body Mass Index (BMI) increases as his testosterone level falls (Ng Tang Fui et al,2014). Male obesity is associated with lowered testosterone (Vermeulen, 1994).

Stress less

When stressed your body releases cortisol’ and increases blood sugar. This hormone can block the effects of testosterone (Sherman et al, 2015). This is because stress (and disease states) accelerate the decline of ‘Leydig cells’ that are located in the testes and responsible for the production of testosterone (Vermeulen, 1994)

Consume more Zinc

Adequate levels of zinc are vital for hormonal balance and reproductive health.
Without zinc, the pituitary gland cannot release the hormones that stimulate the testes to produce testosterone. Insufficient zinc can lead to a reduction in testosterone levels, lowered sperm production, and reduced muscle endurance.

Watch your sugar intake

Testosterone levels decrease after sugar consumption. Studies have found that a 75g of sugar intake causes a 25 per cent drop in testosterone levels for up to two hours after consumption (Caronia et al,2013).

Regular exercise

Regular workouts can boost testosterone levels and help to slow down the decline in this hormone. High-intensity exercises combined with intermittent fasting can be beneficial in increasing testosterone.

Sleep matters

Testosterone is produced mainly during sleep. ‘In older men, morning testosterone levels are partly predicted by total sleep time’ (Leproult, 2011). So getting plenty of uninterrupted sleep does matter.

Limit or avoid alcohol

Alcohol intake lowers testosterone levels and it can also affect your libido and erectile function. Excessive alcohol consumption can also increase estrogen.

Healthy diet

A diet high in fruits, vegetables, nuts, seeds, and fiber will help to raise testosterone and balance estrogen (and protect the prostate gland).

Andropause self-assessment

For a self-assessment of whether you have the symptoms of andropause, the answers to these ten questions may be a starting point.

1) Have you noticed a decrease in your libido (sex drive)?
2) Do you lack energy and are tired more often?
3) Have you lost strength and endurance (or both)?
4) Do you get less enjoyment from life?
5) Have you lost some height?
6) Have you noticed a deterioration in your ability to play sports?
7) Do you find yourself falling asleep after dinner?
8) Has your performance at work deteriorated?
9) Are you prone to feeling moody and sad?
10) Are you lacking in self-confidence?

Recognizing the symptoms of andropause isn’t enough, and men should never set their own diagnosis. The only sure way to check is to have a blood test to confirm your total testosterone level. This should include serum-free testosterone and protein-bound testosterone.

References

Joy K. Anderson,1 Sandy Faulkner,1 Carole Cranor,2 Jennifer Briley,2 Felicia Gevirtz,2 and Susan Roberts Journal of Gerontology: MEDICAL SCIENCES Copyright 2002 by The Gerontological Society of America 2002, Vol. 57A, No. 12, M793-M796 M793

Caronia, Lisa M., Andrew A. Dwyer, Douglas Hayden, Francesca Amati, Nelly Pitteloud, and Frances J. Hayes. 2013. “Abrupt Decrease in Serum Testosterone Levels after an Oral Glucose Load in Men: Implications for Screening for Hypogonadism.” Clinical Endocrinology 78 (2): 291-96. https://www.ncbi.nlm.nih.gov/pubmed/22804876

Fui, Mark Ng Tang, Philippe Dupuis, and Mathis Grossmann. 2014. “Lowered Testosterone in Male Obesity: Mechanisms, Morbidity and Management.” Asian Journal of Andrology 16 (2): 223-31.

Leproult, Rachel, and Eve Van Cauter. 2011.Andropause: Knowledge and Perceptions Among the General Public and Health Care Professionals “Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men.” JAMA: The Journal of the American Medical Association 305 (21): 2173-74. Menopause and Body changes https://www.menopause.org.au/hp/information-sheets/533-menopause-and-body-changes

Morales, A. 2004. “Andropause (or Symptomatic Late-Onset Hypogonadism): Facts, Fiction and Controversies.” The Aging Male: The Official Journal of the International Society for the Study of the Aging Male 7 (4): 297-303.

Matsumoto, A. M. 1993. “‘Andropause’–Are Reduced Androgen Levels in Aging Men Physiologically Important?” The Western Journal of Medicine 159 (5): 618-20.

Sherman, Gary D., Jennifer S. Lerner, Robert A. Josephs, Jonathan Renshon, and James J. Gross. 2015. The Interaction of Testosterone and Cortisol Is Associated With Attained Status in Male Executives. Journal of Personality and Social Psychology.

Singh, Parminder. 2013. “Andropause: Current Concepts.” Indian Journal of Endocrinology and Metabolism 17 (Suppl 3): S621-29.
DOI: 10.4103/2230-8210.123552

Staerman, F., and P. LÃ©on. 2012. “Andropause (androgen Deficiency of the Aging Male): Diagnosis and Management.” Minerva Medica 103 (5): 333-42.

R Steven W.J. Lamberts, Annewieke W. van den Beld, in Williams Textbook of Endocrinology (Thirteenth Edition), 2016 Role of Testosterone During Aginghttps://www.sciencedirect.com/topics/neuroscience/andropause

Vermeulen, A. 1993. “Environment, Human Reproduction, Menopause, and Andropause.” Environmental Health Perspectives101 Suppl 2 (July): 91-100.

deVryer Andropause: Knowledge and Perceptions Among the General Public and Health Care Professionals J.Tampa Rejuvenation. 2014. “How Does Andropause Affect Men?,” February. Youtube. https://www.youtube.com/watch?v=H5q6VHU76Ic.

Yao, Qiu-Ming, Bin Wang, Xiao-Fei An, Jin-An Zhang, and Liumei Ding. 2018. “Testosterone Level and Risk of Type 2 Diabetes in Men: A Systematic Review and Meta-Analysis.” Endocrine Connections 7 (1): 220-31.Yao

Andropause – and the Hormones that Matter to Men

Dr. Derek Koh

Dr. Derek Koh

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