Male Menopause: Is It Real?

Short answer: Yes, but don’t hope for any quick fixes—that’s pharmaceutical industry-think.

Another way to view male menopause: Sure, a ball will bounce, just not as high over time.

I get asked about male menopause all the time, almost always by women (who, admittedly, represent the majority of my patients) and only rarely by my male patients who, for the most part, don’t seem to sense much of a problem.

Could men be viewing male menopause the way they view weight gain? While the vast majority of diet books are sold to women, men tend to respond to weight gain by purchasing larger pants with elastic belts.

Women who want to discuss male menopause are often concerned about declining sex drive in their partners. Just as they’re ramping up their own estrogen with bioidentical hormone replacement and messing the sheets with vaginal lubricants, being Botoxed and dermabraded, they wonder: What about him?

The facts on male menopause
“Male menopause is for real,” I say, “and just as your own menopause comes about from a decline in estrogen levels (which starts in your mid-30s), he’s got the same issue with testosterone.”

It’s also true that some men never have a lot of testosterone to begin with, and losing about 1% of it every year can bring about a group of symptoms in their 50s and 60s that’s officially called hypogonadism, but better known as andropause or male menopause.

A few testosterone facts:
–A guy needs testosterone for muscle-building (20-somethings are loaded with the stuff, and if they exercise they do look great). Your guy’s muscles will start getting flabby during male menopause, especially if he’s no exerciser.

–Testosterone is a source of general energy and sense of well-being, so fatigue becomes probably the most prevalent symptom of male menopause. And remember how estrogen moves in lock-step with your feel-good, stress-buffering serotonin, so that during menopause, with dropping estrogen levels pulling down serotonin, you felt weepy and irritable? During male menopause, his feel-good serotonin falls, too. But instead of getting weepy (although he may do that), he may get nasty and unpleasant–worse than he was. They’re not called grumpy old men for nothing.

–Then there’s the sex drive issue. If you think of yourself, libido is complicated, so please don’t think that ramping up his testosterone is going to fix everything. Did taking estrogen in birth control pills when you were younger, or as bioidentical hormones when you were older, dramatically increase your own libido? Probably not, because your sexual urges are far more complex than just hormone levels.

–While there are many reasons for being fatigued or grumpy beyond the low testosterone of male menopause, I do measure testosterone if a patient is concerned about either of these symptoms. On the rare occasion a man complains of low sex drive, I’ll also measure his testosterone, but generally he beats me to the punch—he’s made the appointment primarily to check his levels. A far more common complaint is erectile dysfunction, so much so that the Viagra family of meds long ago became a recreational drug for Baby Boomer guys. If you want to discuss sex with your partner, and you’re concerned about what seems like flagging interest, I recommend a chat about male menopause and suggesting he get his testosterone levels tested.

If test results are inappropriately low (remember, don’t expect levels of a 20-year-old), the easiest way to restore them to normal is through daily application of testosterone skin creams (AndroGel or Testim). From my own prescribing experience, the testosterone creams prepared by compounding pharmacies are superior to those produced by Big Pharma. This is because the Big Pharma products have a fixed concentration (one size fits all), whereas the compounded products can be gradually adjusted, usually upward, until testosterone blood levels are in the top 10% of normal range.

Research does indeed confirm that long-term testosterone use improves overall quality of life. However, health insurers rarely pay for testosterone if your levels are anywhere within the normal range. Big Pharma’s testosterone is overpriced anyway, averaging $300 monthly. The cost for a compounding pharmacy to produce just what you need is usually less than $100 a month.

In the past there were concerns that testosterone therapy increased the risk of prostate cancer. Based on this now-erroneous thinking (click here for more), many men who had seriously low testosterone were deprived of treatment that could have improved their lives considerably. In Europe, testosterone replacement is allowed even among men who have been surgically treated for prostate cancer, provided their PSA is zero and there is no evidence the cancer has spread.

Additional research in animals has also shown that intravenous ozone therapy can enhance the effect of testosterone skin cream. Ozone (O3), as opposed to oxygen (O2), is a highly potent antioxidant and detoxifier. Ozone is administered via auto-transfusion: about a half cup of blood is removed from you, ozone is bubbled through it, and is then transfused back into you. The procedure takes less than 30 minutes. If you’re interested in ozone, call and schedule a consultation for ozone administration.

Slightly more complicated are weekly injections of testosterone, or small pellets of testosterone inserted beneath the skin. Note there are no testosterone pills to take. Like everything else you ingest, oral testosterone makes its first pass through the liver before entering your bloodstream. Unfortunately, it’s been found to cause liver damage and even liver cancer, so it’s no longer even available.

What to expect with added testosterone? More energy is very likely. Less irritability and brain fog, probably. If he’s a health club regular, he’ll be pleased with some new definition in his abs (“washboard,” however, is pressing your luck).

I suspect the old guy whose photo you see in airplane magazine ads–who physically looks in better shape than 80% of my 20-something patients–would bleed pure testosterone from a paper cut.

And libido? There’s a better-than-even chance of improvement, but like you, he’s complicated.

Be well,
David Edelberg, MD