Q&A: Male menopause

Is it a real thing?

By Thomas Dudrey, MD, internal medicine, at The Portland Clinic

3 middle-aged male friends laughing in a backyard, discussing changes they experience in middle-age.
Q: Is “Manopause” real?

Male menopause, or “manopause”, is a term some people use to describe the hormonal changes that men start to experience in midlife, when testosterone, sperm counts, and sperm quality begin to decline. But these declines happen much more slowly and gradually than the seismic shifts that women experience in menopause. And although testosterone production keeps declining as men age, it never completely stops the way that women’s production of eggs and most ovarian hormones does. In fact, most older men maintain testosterone levels that, while lower, are still considered normal. Truly low testosterone (hypogonadism, or “low T”) is rare.

Q: What common midlife changes in men could be due to low testosterone?

Declines in both sexual interest (libido) and function (erectile dysfunction) are a normal part of aging. Low T can worsen these changes, but so can smoking and many common midlife health issues, including diabetes, obesity, cardiovascular and peripheral arterial disease, and depression.

Q: When should testosterone levels be tested?

Most men don’t need to be tested unless they have significant symptoms, such as decreased body hair, low bone density, depression, or anemia that resists treatment.

Q: When is hormone therapy considered?

Testosterone replacement therapy is not risk-free. It should only be considered if:

  • Symptoms are present and other causes have been ruled out
  • Low T is confirmed by lab tests
  • Prostate cancer has been ruled out
Q: What are the risks of hormone replacement?

Because testosterone is a growth factor for the prostate gland, it can exacerbate enlarged prostate and accelerate any existing prostate cancer. It also can worsen sleep apnea, raise red blood cell counts to harmful degrees, and increase the risk of stroke and heart attack. The risks and benefits should be weighed carefully.

Q: What are the benefits?

For most older men, testosterone replacement is not beneficial, and the evidence for improving sexual function is poor. But for confirmed hypogonadism, it can improve subjective measures of fatigue, erectile dysfunction and low libido. And if low T is driving depression or bone loss, it can potentially
improve these.

Q: Are there other ways to improve midlife symptoms?

Treating underlying health conditions that mimic low T (diabetes, obesity, vascular diseases, high cholesterol, hypertension, enlarged prostate, depression) often improves some or all of the symptoms. In addition, exercising, eating a healthy diet, maintaining a healthy weight, and avoiding tobacco and excessive alcohol are proven ways to manage health and slow the effects of time.

Dr. Dudrey sees patients at The Portland Clinic’s downtown office.