‘Male menopause’ … ‘andropause’ … vague, cheeky expressions given to middle-aged men suffering an apparent change-of-life. You might see them swapping their SUVs for a convertible or Harley Davidson, ‘Mamils’1 on their race-bikes, or guys with ill-fitting toupées in unnatural tints …
Just for a laugh, watch ex-KGB, hairy mid-life ‘Viktor’ – that ‘v-e-r-y unattractive man’ in the 90s comedy series Fast Forward – try to be the stud. Thankfully, he’s not always the prime example for men of this vintage!
But I shouldn’t make light of a condition that’s now been scientifically termed and documented.
The trusted Mayo Clinic in the US states that ‘male menopause’ occurs when male testosterone levels (I’ll call it T-levels) decrease with age. Importantly, it says that hormonal changes in men happen gradually as opposed to those of women – only about 1% a year after the age of 40. T-levels of most older men actually remain normal, and only 10% to 25% have below average readings. Terms for this slow decline are ‘late-onset hypogonadism’ (i.e. low T-levels in older men) or ‘age-related low testosterone’.2
Because changes are slow, often with no signs at all, a man’s low T-levels can be easily ignored or dismissed. To complicate things, low T can be linked to the man’s age, medications, or poor health (e.g. a BMI of 30 or over). The Mayo Clinic lists the main symptoms:
- ‘Reduced sexual desire and activity
- Decreased spontaneous erections or erectile dysfunction
- Breast discomfort or swelling
- Height loss, low trauma fracture or low bone mineral density
- Hot flushes or sweats.’3
The man with low T may also have a string of other lows: in energy, drive, self-esteem, mood, concentration, sleep, anaemia, muscle mass and strength. The only high he suffers isn’t good either: BODY FAT.4
I know I go on about fat, but a man’s high BMI (body-mass index) is usually the result of binge-eating junk foods, too much beer and little or no exercise. And as you’ll read here, belly fat does in fact lower T – actually raising female hormones and wreaking havoc with the man’s body image and self-worth. Depression follows, and the feeling of helplessness that life’s passing by ‘too quickly’, so common at this stage of life.
Undiagnosed low T-levels in men can also cause osteoporosis, especially with a sudden decrease in this hormone (as with menopausal women). This could be caused by steroid hormone medication (glucocorticoids) and cancer (especially prostate cancer) treatments. But because the benefits gained by testosterone HRT are still unclear, osteoporosis in men is commonly treated with medication alone.5
Now that we know the symptoms, what should guys do?
- Get a blood test to confirm low T-levels.
- Get re-tested if results show a low T.
- Check that the pituitary gland (found at the base of the brain which regulates sex hormones) is working correctly.6
HRT for men + the risks
Although the benefits of testosterone replacement for men are inconclusive, some physicians still recommend it for older males with low T-levels (specifically to improve sexual function) and even for those with no signs or symptoms. Results have been mixed: positive for some patients but not for others. The important thing to note is that there are strong risks associated with T-replacement, such as:
- prostate and breast cancer (with metastatic or secondary cancers)
- increasing risk of heart attack and stroke
- aiding formation of blood clots in veins.7
T-levels & exercise
A 2008 National Institutes of Health study tested the effects of exercise on male sex hormones. Sedentary men aged 40 to 75 years took part in the study for a year. Exercise involved moderate aerobics for 1 hour per session. It found increased levels of the male hormone dihydrotestosterone (DHT) and sex-hormone-binding globulin (SHBG), but no marked increase in testosterone and free testosterone. While higher DHT is a good sign (it’s a more powerful hormone than testosterone), higher SHBG actually means more testosterone is bound in the body, meaning less of it is available.
So while this is a mixed result on the impact of aerobic exercise on T-levels, it’s no reason for men not to exercise. Watch my earlier video featuring 80-year-old gym-regular Nick and how he’s kept himself fit and strong because of it.
Inside the male mind
Psychological aspects can’t be ignored. I’ve personally observed that fear is a major contributing factor to men’s change of behaviour. A younger, fitter man commands more attention and his ego is stroked (and stoked). Our ageing middle-aged bloke feels neglected and overlooked.
It’s true that men at their low point from 55 onwards don’t get the same amount of sympathy as women going through their change of life – mainly because effects are not obvious. Men don’t get hot flushes, mood swings or night sweats that women do.
A lot may also depend on what’s happening at home. A supportive, caring partner, together with children who love and respect their Dad are important pillars in a man’s life. His ego needs to be preserved and sustained. He needs to be wanted and loved. He needs to have a job and be respected by his colleagues and peers. And in the Australian tradition, he needs to have weekly chat sessions with his mates at their favourite pub.
On the reverse side, there could be divorce, or loss of a job. Men might still have their mates and the weekly pub binge – but this leads to more unhealthy habits, including growth of the pot-belly (I discuss this in Move! 4.0). Men don’t cope as well as women in such situations.
Men continually crave appreciation from their partners. Thank-yous and ‘you’re wonderful darling’ are often missing. Just being ‘the bloke’ who always takes out the garbage or mows the lawn is not enough.
A woman’s needs are completely different, especially after she becomes a mother. Women invariably become braver, more resilient and independent. While they grow and change, their male partners habitually continue on the path they’re most accustomed to. What was once a relationship where the man could do no wrong can often become one where the braver, emancipated woman demands more from it.
Have you noticed that middle-age men seem to communicate better with each other? Women in that age group likewise get on better with women. And haven’t you seen the sexes quickly separate when groups of couples walk together?
But funnily enough, I’ve observed that same-sex relationships in later life seem to work better – where physical changes are about the same for each, thereby enabling a stronger emotional bond.
So men, I’ve prepared you.
Baby boomers: if you think you’ve lost your mojo, get a blood test to see if there’s a physical cause.
Gen Xs, Ys and Zs: You may well say ‘but we’re not there yet’ … but with every day that passes you will be – and sooner than you think! You now have the weapons to deal with middle-age.
And I must keep repeating to all of you: DIET & EXERCISE. DON’T WAIT TILL IT’S TOO LATE!
1‘Middle-Aged Man/Men in Lycra’.
2Mayo Clinic Staff (June 20, 2020). Men’s Health: Aging-related hormone changes in men are different from those in women. Understand the signs, symptoms and treatment options. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056
3 Mayo Clinic.
4 Mayo Clinic.
5National Institutes of Health [NIH], (October 2018). Osteoporosis in Men. Retrieved from https://www.bones.nih.gov/sites/bones/files/pdfs/osteopinmen-508.pdf
6 Mayo Clinic.
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