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The male menopause - is it real and should it be treated?

September 16, 2013
Research published this month in The New England Journal of Medicine reports that middle age men with symptoms thought to be related to testosterone deficiency could be due to low oestrogen levels. Testosterone is converted to oestrogen by the hormone aromatase. That means the lower the levels of testosterone, the lower the levels of oestrogen too. Low oestrogen levels could be responsible for weight gain, lack of sexual desire and lethargy reported by many middle-aged men. But is there really such a thing as the male menopause and should men be considered for hormone replacement therapy? Dr Mark Vanderpump, Consultant Endocrinologist at The Physicians’ Clinic explains some of the background to the study and comments on the findings.

What is the male menopause?

The 'male menopause', sometimes called the 'andropause', is a term used to explain why some men develop depression, loss of sex drive, impotence and other physical and emotional symptoms when they reach their late 40s to early 50s. “The label menopause is used because the symptoms thought to be due to a natural drop in the hormone testosterone in middle age, and therefore similar to the changes in hormonal levels that occur in women of the same age. However, although testosterone levels in normal, healthy men decline steadily by about 1–2% a year from around the age of 40 years, the reported symptoms are often nothing to do with testosterone deficiency,” stresses Dr Vanderpump. “Lifestyle factors or psychological problems can often be responsible for many of the symptoms as can drinking too much alcohol, having poor sleep and being overweight or obese,” he says.

How is hormone deficiency in men diagnosed?

“A blood test at 9am can reliably measure testosterone levels. If the results suggest that there is evidence of testosterone deficiency (hypogonadism), patients are usually referred to an endocrinologist. If the specialist confirms this diagnosis, testosterone treatment can be offered to correct the hormone deficiency. “ “In clinical practice it can be very difficult to distinguish between patients who are truly testosterone deficient (and who would therefore benefit from testosterone supplements) from those who have physiological changes. The latter group would probably not be helped by hormone therapy and would benefit more from support to make lifestyle changes.”

Hormone therapy may have adverse effects

Testosterone therapy in those not truly deficient is not risk-free. Men can develop thickening of the blood (polycythaemia) and their prostate can enlarge as a result. “This study has suggested that it is not only a fall in testosterone but also a decline in oestrogen levels that may be responsible for some of these findings in men. As testosterone is converted into oestrogen in men by aromatase any therapy must not overlook the importance of this second hormone. Targeting oestrogen and ensuring that the testosterone preparations used allow conversion to maintain adequate levels of oestrogen may provide a better response in these patients,” concludes Dr Vanderpump.

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