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The Male Menopause: Andropause

By Jan Nelson MSN, NP-C, ABAAHP


   The counterpart to the female menopause is called andropause (or the “male menopause”). Testosterone levels in men begins to decline with aging beginning in the early 30’s and by age 40 levels naturally decline by 1% per year. However, the decline in male hormone production is much more gradual than the decline in female hormone production.

     Testosterone performs many roles, some of which are protecting the cardiovascular system by widening the lumen of the coronary arteries, increasing blood supply to the heart, reduces serum cholesterol and minimizes atherosclerosis, reduces high blood pressure by vasodilatation, increases fibrinolytic activity of the blood giving the capacity to oppose blood clot formation and dissolve blood clots. Testosterone protects against obesity and diabetes by increasing the efficacy of insulin to make glucose penetrate into the brain, the muscles, the heart and other lean tissues targets. It supports the brain and nerves by increasing blood supply and the number of connections between neurons. Bone strength and density are sustained as well as muscle mass and strength. Testosterone improves mood and memory, reduces anxiety as well as maintains sexual function.  

     Low levels of testosterone can result from diabetes, liver disease, hemochromatosis, obesity, smoking, chronic alcohol use, and medications such as ketoconazole, cimetidine, and glucocorticoids. Symptoms associated with low testosterone are: loss of drive and competitive edge, reduced libido, decreased level of fitness and effectiveness of workouts, joint pain and decreased muscle fitness, increased brain aging – decreased memory, increase in heart attack and stroke risk. Increase in fatigue, depression/mood changes and irritability. Other factors that can contribute to testosterone decline are diet and insulin resistance, stress and toxin exposure.

      As men age, the balance between testosterone and estradiol might tilt in favor of estradiol production. The pituitary hormone responsible for stimulating testosterone is LH (luteinizing hormone). Too much estradiol may decrease the level of LH and, therefore, the level of testosterone.

     For over sixty-five years, there has been a fear that testosterone therapy will cause new prostate cancers to arise or hidden ones to grow. This long-standing fear about testosterone and prostate cancer has little scientific support according to Morgentaler, A, Can J Urol. “Low blood levels of testosterone do not protect against prostate cancer and, indeed, may increase the risk. High blood levels of testosterone do not increase the risk of prostate cancer. Treatment with testosterone does not increase the risk of prostate cancer, even among men who are already at high risk for it.”

     Contraindications for testosterone therapy are: active prostatic carcinoma, breast cancer, prostate nodules or indurations, unexplained PSA elevations, erythrocytosis, unstable congestive heart failure, and severe untreated sleep apnea.

       Testosterone therapy for men is based on a personal hormone test results to determine the testosterone dosage that fits the needs of the person.  Bio-identical hormone replacement therapy that includes testosterone addresses the cause of the problem…not just the side effects, while offering a combination of additional long-term health benefits.  Corrections to hormonal imbalances can be made via topical creams applied once or twice a day, injections or pellet insertions. We will discuss these options with you to help you decide what works for you.  

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