Is There a ‘Male Menopause’? Testosterone Decreases with Age

Is there a ‘Male Menopause’? The accurate answer to this question, of course, is no, as menopause refers to the cessation of menstruation in women. However, once a man reaches the age of 30, the testosterone production in his body will decrease by an average rate of 1-2% per year.

This slow drop of testosterone levels in men is commonly known as “male menopause” or andropause. Unlike menopause, andropause does not have a menstruation mark to determine this transition. The rate of at which testosterone decreases can vary quite substantially, depending on the man. Many men in their 70’s have testosterone levels that are equal to those of an average 30-year-old male!

Why is testosterone important?

Testosterone is the androgenic hormone produced mainly in the testes and, in lesser quantities, by the adrenal glands. It is primarily responsible for normal growth and development of the male reproductive organs. It also facilitates the development of secondary male sex characteristics such as male hair pattern, musculature, fat distribution and bone mass. In addition, normal testosterone levels are important for healthy mood, energy levels, fertility and sex-drive.

What are the symptoms?

The symptoms of andropause may be pronounced, or they may be subtle and frequently go unnoticed. Symptoms include:

• Reduced sexual function
• Loss of libido, difficulty to obtain or maintain an erection
• Loss of spontaneous erections especially during sleep/early morning
• Reduced sperm production and ejaculatory volume
• Reduced growth of facial and body hair
• Smooth, dry skin
• Reduced muscle mass
• Increased body fat and gynecomastia
• Reduced bone mass
• Mild anaemia
• Fatigue, reduced energy and vitality
• Mental changes such as depression, poor cognition and reduced concentration and memory

In addition to these changes, a low testosterone level is also associated with various medical conditions such as:

Diabetes: A clear link between diabetes and low testosterone has been established. Men with diabetes are more likely to have low testosterone levels. Conversely, men with low testosterone are more likely to develop diabetes later in life. Testosterone helps the body’s tissues take up more glucose (sugar) from the bloodstream in response to insulin.

Men with low testosterone more often have insulin resistance; they need to secrete higher levels of insulin to keep blood sugar normal. Insulin resistance is a precursor to diabetes. As many as half of men with diabetes have low testosterone. Scientists aren’t sure whether diabetes causes low testosterone, or the other way around. More research is needed, but short-term studies show that testosterone replacement may improve blood sugar levels and obesity in men with low testosterone.

Obesity: Men with very low testosterone levels are more likely to become obese. Fat cells metabolize testosterone to estrogen (a process called aromatisation), which lowers testosterone levels. Obesity also leads to decreased levels of sex hormone-binding globulin (SHBG), a protein that carries testosterone in the blood. Losing weight through exercise can increase testosterone levels. Testosterone supplements in men with low testosterone can also reduce obesity.

Metabolic syndrome: Metabolic syndrome is a condition that includes the presence of abnormal cholesterol levels, high blood pressure, obesity, and high blood sugar. Metabolic syndrome increases the risk for heart attacks and strokes. Studies show that men with low testosterone are more likely to develop metabolic syndrome.

Natural ways to boost testosterone levels

EXERCISE: What seems to optimally affect testosterone levels is to use the greatest volume of muscle to your maximum level of intensity within each exercise. That means using multiple muscle groups within each exercise, to the point where your muscles fail (i.e., you cannot complete another repetition using acceptable form). Since your leg and back muscles are the largest muscle groups, exercising these areas will increase testosterone levels the most. Deadlifts, squats and bent-over rows engage the core muscles and even the upper body along with the legs and back within a single exercise (compound exercise). Your bloodstream will be coursing with testosterone after just one set (yes, the increase is that immediate)!

NUTRITION: Foods rich in Zinc (most meats, almonds, pumpkin seeds) and Selenium (Brazil nuts, tuna) can boost testosterone levels. Both these minerals aid in testosterone production. The body also depends on Vitamin B6 (beef, eggs, avocado, bananas) to produce testosterone. Vitamin B also promotes absorption of zinc from dietary sources. Magnesium (spinach, black beans, pumpkin seeds) is the base nutrient for over 300 enzymes that regulate everything from sleep, to insulin sensitivities and, in this case, testosterone.

Essential fatty acids such as the Omega 3 fatty acids found in fish and flaxseed, as well as saturated fats, are essential for normal testosterone production. All steroid hormones (such as testosterone) are produced from cholesterol and when fats are deficient in the diet, this process will be inhibited. Studies clearly indicate that diets higher in protein, lower in carbohydrates, and moderate in fat cause the greatest sustained increase in testosterone levels.

SLEEP: Testosterone levels gradually increase throughout the night and peak in the early morning. According to a recent article published in the Journal of the American Medical Association (JAMA), cutting back on sleep leads to a drastic reduction in male testosterone levels.

ALCOHOL REDUCTION: Healthy normal men, consuming reasonable amounts of alcoholic drink, experience a 20% drop in their serum levels of testosterone. In chronic alcoholics with extensive liver damage, testosterone levels can be reduced by as much as 50%. Alcohol consumption should be limited to 21 units per week (no more than 4 units daily) and is best avoided when actively trying to increase testosterone levels.

Testosterone Replacement Therapy (TRT)

Current treatment options include oral tablets or capsules, injections, implantable slow-release pellets, and transdermal (through the skin) patches and gels. The decision to start TRT has to be made carefully, as unwanted side effects such as fluid retention, liver toxicity, prostate enlargement, sleep apnea and fertility problems can occur. You should only consider this treatment option after consulting your doctor and undergoing complete diagnostic tests.

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References:

1. Androgen deficiency in older men: Indications, advantages and pitfalls of TRT – Cleveland Clinic Journal of Medicine November 2012 vol. 79 11 797-806

2. Joshi D, van Schoor NM, de Ronde W, et al. Low free testosterone levels are associated with prevalence and incidence of depressive symptoms in older men. Clin Endocrinol (Oxf) 2010; 72:232-240.

3. Does last week’s alcohol intake affect semen quality or reproductive hormones? A cross-sectional study among healthy young Danish men.Hansen ML, Thulstrup AM, Bonde JP, Olsen J, Håkonsen LB, Ramlau-Hansen CH. Reprod Toxicol. 2012 Nov;34(3):457-62.

4. Brilla, L. R. and Conte, V. (1999) A novel zinc and magnesium formulation (ZMA) increases anabolic hormones and strength in athletes. Medicine and Science in sports and Exercise, 31, 483

About the Author

Nathan Curran is a London based medical doctor with a special interest in weight management and personal fitness. He is largely involved in the corporate sector, delivering seminars which focus on the development of physical resilience within the workplace and well-being promotion. He obtained both his medical degree and postgraduate honours degree in human genetics and physiology from the University of Stellenbosch. He was also recently involved/featured on a prime time British television series “Embarassing Bodies – Live from the clinic.”