Q&A: Facts vs. fiction of male ‘menopause’

Dr. Allan Alberton provides medical insight for men and what to expect during their change of life

Menopause can be a traumatic transition for women.  But what about men?  What can they expect during their change of life?  We talked to Dr. Allan Alberton, a board certified family medicine practitioner at Winter Haven’s Bond Clinic, about the so-called male menopause.

Central Florida Health News (CFHN): Is there such a thing as male menopause?  What does it consist of?

Dr. Allan Alberton: The term male menopause or “andropause” itself is not used by most medical professionals.  More commonly, the terms hypogonadism, or testosterone deficiency are utilized.  Even low-T is not medically used.  That is more of a relatively recent direct-to-consumer pharmaceutical branding term that has caught on with the public.  As men age, there is definitely a decline in testosterone levels, compared to that same individual years earlier.  Serum levels may start gradually decreasing at age 30.  Symptoms can include fatigue, decreased libido, weakness, and psychological changes.

CFHN: Can some men weather male menopause with little or no noticeable effects?

Dr. Alberton: Yes.  Many may have little to no complaints.  Most of the effects are non-specific to testosterone deficiency.  This is why a detailed history, physical exam, medication, history, social habit intake (tobacco use, alcohol, drug use, supplements, etc.), supplement history, surgical history, and psychiatric history, in addition to actual testosterone measurements, are very important factors in differentiating true testosterone deficiency with other medical conditions.

CFHN: Are there ways to minimize the effects of male menopause?

Dr. Alberton: An overall healthy lifestyle is key to tolerating any pathological or physiological age-related deficiency in testosterone—or any other medical condition.  What I mean is, an overall equilibrium with mind and body as follows:

  1. Physical exercise more days than not;
  2. No skipping meals, instead there is overall calorie restriction per 24-hour period to avoid obesity (#1 and #2 are achieved through daily food and exercise journaling);
  3. Proper hydration with mostly water;
  4. Avoidance of nicotine or drug habits;
  5. Proper sleep schedule through sleep hygiene habits;
  6. Moderation in alcohol; and
  7. Mental well being with hobbies, interests, reading, and any other continuous learning process, independent of age, to potentially slow down memory loss or accelerated progression of dementia.

CFHN: What kind of symptoms can men expect as they age and testosterone levels drop?  Are the symptoms as dramatic, or noticeable, as they are for women in menopause?  Please explain.

Dr. Alberton: Symptoms may be non-specific, such as fatigue, irritability, or changes in the body due to alteration in muscle mass and fat distribution.  These can be easily seen as normal age-related changes that vary from individual to individual.  Symptoms can also be more specific: Decreased libido, infertility, or lack of erections or rigidity with erections.  Since most symptoms are not very specific to testosterone deficiency, the gradual decline may not be noticed right away.

CFHN: Can men expect declines in fertility?  Like women, do they need to be concerned about their biological clocks and potential health risks to children because of advanced paternal age? 

Dr. Alberton: Although lower fertility does occur as men age, usually concerns about a “biological clock” are not often an issue.  The gradual decline is occurring after most have already started and are potentially no longer adding to the family.  Also, there have been many cases where men are still becoming fathers in their 70s and 80s.  Potential mutations in sperm and changes in sperm motility can occur more often at that age.  However, that does not always affect fertility.  Actually, supplementation in men with hyogonadism may further suppress sperm production.  For patients considering retaining their fertility, testosterone replacement should be deferred and discussed with their physician.

CFHN: Is testosterone replacement popular with men?  When is it advised?  What kind of risks are associated with replacement therapy?

Dr. Alberton: Testosterone replacement has existed for several decades, mostly in the form of injection.  However, topical applications have become popular recently.  Most physicians would probably agree there has been a significant rise in patient requests for testosterone testing since there have been more direct-to-consumer ads.

Testosterone supplementation is advised when patients present with signs and symptoms, and when there are clinic laboratory findings of testosterone deficiency.  The Endocrine Society Task Force does not recommend routine general population screening in asymptomatic men.  In addition, some insurance providers will not cover testing if the reason behind ordering it is erectile dysfunction or impotence.

Supplementation is not for all, even if levels are truly low.  The benefits vs. risks when starting any therapy are always the consideration in medicine, regardless of diagnosis.  Individualized therapy and consideration are key rather than a cookie-cutter approach.  Caution in patients with enlarged or cancerous prostates is to be considered.  Caution in patients with known uncontrolled hypertension and heart failure are considerations as well.  Fertility may be affected by treatment; patients considering treatment should be made aware of that.  Changes in skin, fluid retention, breast enlargement, male pattern baldness (usually familial), worsening of sleep apnea, decreasing urine flow, amongst other potential adverse effects—as well as a specific reaction to the pill, shot, or topical testosterone itself—can occur.

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