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Andropause: Causes, symptoms of male menopause, tips to help mitigate its effects

As men age, they experience a gradual decline in hormone levels, particularly testosterone and this natural process is known as andropause or late-onset hypogonadism and often referred to as the male menopause but while not as well-known or universally recognised as menopause in women, andropause can significantly impact a man’s physical health and emotional well-being. Unlike menopause in women, andropause occurs more subtly and over a longer period, typically starting around the age of 40 and progressing over decades.

Andropause: Causes, symptoms of male menopause, tips to help mitigate its effects (Photo by Cynthia Magana on Unsplash)

In an interview with HT Lifestyle, Dr Shweta Goswami, Founder and Medical Director at Zeeva Fertility in Noida, shared, “Though a lot of discussion happens around female menopause and everyone knows that a lot of females undergo menopause with decline in the number eggs in her ovaries. However very little is attention is unfortunately given to male menopause which is also called as Andropause. Though it’s a scientifically known fact, serum testosterone tends to decline by a percent every year for men above 40 years of age, however a lot has not been spoken about it and there is lack of awareness.”

She added, “Most older men while may have testosterone levels in the normal range but an estimated 10-25% undergo andropause. Some of the common known symptoms of Andropause are like reduced sexual desire, erectile dysfunction, bone loss, decreased energy levels, depressed and poor work concentration. If anyone has any of these symptoms , it is recommended by all endocrine societies that testosterone levels, should be checked and replaced, if required . It’s a very unmet need for men because most men shy away from the fact and don’t talk about it, however it is a scientific fact, and more information should be available in the public domain.”

Dr Anshika Lekhi, Senior Consultant Gynecologist and Fertility Specialist at Cloudnine Group of Hospitals in Gurgaon’s Golf Course Road, echoed, “Andropause refers to the age-related decline in testosterone levels and the accompanying symptoms experienced by men. Unlike menopause, which is a sudden cessation of reproductive function in women, andropause is a gradual decline in hormone production. It usually occurs in middle-aged or older men, typically starting in their 40s or 50s, although the onset and severity can vary from person to person.”

Causes of Andropause:

Dr Anshika Lekhi highlighted, “The primary cause of andropause is the age-related decline in testosterone production. Testosterone levels typically decrease by about 1% per year after the age of 30.” However, other factors can contribute to the onset and progression of andropause, including –

• Lifestyle factors: Unhealthy lifestyle habits, such as poor diet, lack of exercise, excessive alcohol consumption, and smoking, can accelerate the decline in testosterone levels and exacerbate the symptoms of andropause.

• Chronic health conditions: Certain chronic conditions, such as obesity, diabetes, hypertension, and cardiovascular disease, can affect hormone production and contribute to the development of andropause.

• Medications and treatments: Certain medications, including some antidepressants, corticosteroids, and opioids, can interfere with testosterone production. Additionally, treatments like chemotherapy or radiation therapy for cancer can also impact hormone levels.

• Psychological factors: Psychological stress, depression, and anxiety can have a reciprocal relationship with andropause. Hormonal changes can contribute to emotional disturbances, while emotional well-being can also influence hormone regulation.

Symptoms of Andropause:

Dr Parul Prakash, Reproductive Medicine (IVF) at Artemis Hospital in Gurugram, said, “During andropause, testosterone, a key hormone responsible for male reproductive function, starts to decline which can lead to various physical and emotional changes, including reduced libido, fatigue, mood swings, and decreased muscle mass.” She added:

– Andropause can affect a man’s reproductive capacity. Due to andropause, sperm production may decrease, and the quality of sperm can be compromised because of hormonal fluctuations.

– Andropause can contribute to erectile dysfunction as well. The decrease in testosterone levels can affect blood flow and nerve function, impacting a man’s ability to achieve and maintain erections. However this is not the case for all men.

– Andropause can also have psychological effects, including irritability, depression, and decreased self-confidence, all of which can indirectly impact a man’s fertility journey by affecting overall well-being and relationship dynamics.

According to Dr Anshika Lekhi, the symptoms of andropause can vary widely among individuals where some men may experience only mild symptoms, while others may have more pronounced effects. She listed the common symptoms of andropause as –

• Decreased energy levels and fatigue: Men going through andropause often report a decrease in energy levels, feeling tired and fatigued even with adequate rest.

• Sexual changes: Many men experience a decline in sexual desire (libido) and may have difficulties achieving or maintaining erections (erectile dysfunction). Additionally, there might be a decrease in sexual spontaneity and a longer recovery time between sexual encounters.

• Mood changes: Andropause can cause mood swings, irritability, increased anxiety, and even depression in some individuals. These emotional changes may be attributed to hormonal fluctuations and the psychological impact of dealing with aging-related concerns.

• Muscle and bone changes: Testosterone plays a crucial role in maintaining muscle mass and bone density. During andropause, men may experience a decrease in muscle mass, strength, and bone density, potentially leading to increased frailty and the risk of osteoporosis.

• Changes in body composition: Andropause can contribute to an increase in body fat, particularly around the abdomen. This change in body composition can lead to a decrease in overall physical fitness and self-esteem.

Treatment Options:

Dr Parul Prakash suggested:

– Lifestyle changes such as a balanced diet, regular exercise, and adequate sleep can help mitigate its effects. Hormone replacement therapy (HRT) may be considered in certain cases to stabilize testosterone levels and improve fertility potential.

– Men concerned about the impact of andropause on their fertility can consult with a fertility specialist. A thorough evaluation, including hormone level testing and a comprehensive medical history, can help determine the best treatment.

– For couples trying to conceive during andropause, it’s important to plan ahead. Fertility experts can provide guidance regarding optimal timing, assisted reproductive technologies, and potential challenges associated with age-related fertility decline.

– Fertility experts can offer psychological support and strategies as well to help men in dealing with the physical and psychological aspects of andropause.

Dr Anshika Lekhi asserted that men experiencing symptoms of andropause should seek medical advice for proper diagnosis and guidance on suitable treatment options. The following approaches are commonly used to manage andropause:

• Hormone replacement therapy (HRT): In some cases, testosterone replacement therapy may be recommended to address the hormonal imbalance associated with andropause. HRT can help alleviate symptoms such as low libido, fatigue, and mood changes. However, it is crucial to work closely with a healthcare professional to determine the appropriate dosage and to monitor potential side effects.

• Lifestyle modifications: Making positive lifestyle changes can significantly impact andropause symptoms. Regular exercise, a balanced diet rich in essential nutrients, stress reduction techniques, and adequate sleep can help improve energy levels, mood, and overall well-being.

• Psychological support: Counseling or therapy may be beneficial for men dealing with emotional challenges associated with andropause. Addressing psychological factors, learning coping mechanisms, and developing a positive mindset can help navigate this phase of life more effectively.

• Medications for specific symptoms: Depending on the individual symptoms experienced during andropause, medications such as phosphodiesterase type 5 inhibitors (e.g., Viagra) may be prescribed to address erectile dysfunction, or antidepressants may be considered for mood-related concerns.

She concluded, “Andropause is a natural process that many men experience as they age. It involves a gradual decline in testosterone levels and can manifest in various physical and emotional symptoms. While the concept of andropause is not universally accepted, recognizing and understanding the symptoms can help men seek appropriate medical support and explore suitable treatment options. Through hormone replacement therapy, lifestyle modifications, psychological support, and targeted medications, men can manage the symptoms of andropause and maintain a fulfilling and healthy life as they age. It is crucial for individuals to consult with healthcare professionals to receive personalized advice and guidance tailored to their specific needs.”

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