Monday’s medical myth: men also go through menopause

AUTHOR

1. 

   Carolyn Allan

   Clinical Research Fellow at Prince Henry's Institute

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Carolyn Allan does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

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Men’s testosterone decline isn’t quite the same as menopause. Andres Thor

Feeling tired and grumpy? Maybe a litte emotional? If you’re a middle-aged male, these symptoms might be hormone-related, but no, you’re not going through man opause.

It’s true that signs of men’s low testosterone are similar to symptoms of menopause: low energy, mood swings, irritability, poor concentration, reduced muscle strength and bone density, and a lack of interest in sex.

But unlike women, whose oestrogen levels fall rapidly when they go through menopause, men’s testosterone declines much more modestly and gradually.

Testosterone levels in men are highest between the ages of 20 and 30 years, and from from 30 to 80 years they drop by around a third. Some men will experience a greater drop than others, particularly if they’re overweight or obese.

Testosterone is essential for good health because it stimulates the growth of muscles, bones, and the bone marrow that makes red blood cells.

So testosterone or “androgen” deficiency – which affects one in 200 Australian men under 60 – can have a major effect on the body’s ability to function normally.

The “manopause” myth has been perpetuated by the interest in testosterone replacement therapy (TRT) as an elixir of youth to improve the symptoms and signs of ageing.

Testosterone therapy offers benefits for men with known causes of androgen deficiency, but there is a lack of data to define the level of deficiency that warrants this treatment.

If the cause of androgen deficiency is unknown, treatment needs to be tailored to the individual. Testosterone treatment certainly shouldn’t be requested or prescribed in the belief that it’s a “cure-all” for symptoms of ageing.

For ageing men without classic androgen deficiency the jury is still out on the effectiveness of testosterone replacement therapy.

The safety of the treatment – particularly on the prostate and cardiovascular system – is unclear, and the benefits seem relatively modest. There is certainly no remarkable return to youthful vigour.

Often, low testosterone levels can be a sign of underlying health conditions. Low testosterone levels are associated with various chronic diseases such as diabetes, heart disease and depression.

The Massachusetts Male Ageing Study (the largest study of male ageing) found that chronic illness, use of prescription medication, obesity or excessive alcohol intake were associated with a 10 to 15 per cent reduction in serum testosterone levels (testosterone in the blood) in men aged over 40 years.

Treatment, then, should focus reducing the risk factors for these conditions (i.e. weight loss, reduced alcohol intake) rather than the testosterone level.

While the idea that men, too, go through menopause might be a playful explanation of the ageing process, it shouldn’t be taken too seriously, especially if serious symptoms of chronic diseases are dismissed.