Andropause: What You Should Know about Male Menopause


What You Should Know About Male Menopause

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Almost everyone is familiar with the term menopause, which refers to the end of a woman’s reproductive years. What some people don’t know is that men also go through a similar transition, known as andropause or male menopause, during their later years. In both cases, the transition is associated with hormone deficiencies and tends to coincide with other age-related declines. Fortunately, appropriate hormone treatment generally provides symptom relief, and also tends to delay other age-related illnesses or conditions.


Andropause is not considered to be a disease, nor is it the same as the “midlife crisis” some men exhibit as they age. Most midlife crises occur 10 to 20 years before andropause and may be indicative of the beginning of the decline, similar to symptoms of pre- or perimenopause in women.

The existence of andropause has been debated for years, but has recently gained recognition as a very real physiological state of hormone deficiency. Yet there is still controversy over an exact definition. Some practitioners define andropause as the inability to have a penile erection; others associate it with a marked decline in hormone levels. What most agree on is that andropause is the result of a very gradual, age-related decline in hormones such as testosterone, DHEA, and others.

Between the ages of 25 and 50, men’s testosterone levels tend to decrease by approximately 10% per decade, yielding over a 50% reduction by the time they reach their 60s. Because it is such a slow decline and men’s responses to it vary widely, andropause is difficult to detect. The fact that men generally do not discuss symptoms as readily as women, also makes it more difficult to diagnose.

During this period of testosterone decline, men’s estrogen hormone levels tend to increase by almost 50%, drastically altering their hormone balance. This change in the ratio may help explain why many men begin to feel more family-oriented and nurturing as they age.

Factors that accelerate the decline of hormones such as testosterone and DHEA include:

• excess weight, especially abdominal obesity
• illness, disease, or other stressful events
• tobacco consumption
• drug or alcohol abuse
• depression or mental illness
• reduced sexual activity

Common Symptoms

Similar to menopause, the effects of andropause are not uniform and each man’s response to it is unique. That said, there are commonly reported symptoms, many of which are considered part of the “normal” aging process (see chart on next page), but which are also accelerated by a testosterone deficiency.

Symptoms of testosterone deficiency tend to fall into one of four categories: physical, cardiovascular, mental, or sexual, with some of them overlapping. For example, feeling too weak or tired to engage in sex could be related to impaired cardiovascular health, feelings of insecurity, and decreased libido, all of which may be related to a testosterone deficiency.

Symptoms Associated with Andropause

• Balding head
• Reduced body hair, especially armpits and genital area
• Decreased muscle mass, with increased body fat
• Reduced strength and stamina
• Feeling weak or tired
• Decreased testicle size
• Enlarged prostate
• Urinary discomfort and/or difficulties

• Increased abdominal fat, increasing risk of heart attack
• Increased insulin, cholesterol, and triglyceride levels
• Elevated blood pressure
• Diminished coronary artery elasticity
• Weakening of the heart muscle

• Moodiness, irritability, insecurity
• Inner unrest
• Lack of concentration
• Memory failures
• Reduced intellect and critical thinking

• Decreased sex drive and arousal
• Reduced organ sensitivity or pleasure
• Fewer orgasms
• Erectile dysfunction

One of the most troubling symptoms men encounter as they age is an enlarged prostate. The prostate gland goes through a second growth spurt as men reach their 40s, 50s, or 60s, often resulting in benign prostatic hyperplasia (BPH). As the prostate grows, it pushes on the bladder and urethra, causing mild to severe urinary discomforts such as increased frequency of urination, especially at night; difficulty initiating urination; decreased urinary force; and the sensation of a full bladder, even after urinating.

Current medical research indicates that low testosterone levels may be associated with BPH, especially when coupled with elevated estrogen hormone levels.

Treatment Options

With increasing life spans, the number of years that a man might live with hormone deficiencies also increases. The earlier that a hormone imbalance is detected and treated, the better. Hormone supplements can provide symptom relief while delaying other age related declines.

Because andropause has not been studied as much as menopause, some healthcare practitioners may not suggest hormone treatment unless you ask about it. Some practitioners may also maintain a lingering concern over testosterone supplements, primarily due to past abuse by athletes who injected synthetic steroids to build muscle mass.

The testosterone treatments available today such as oral capsules, sublingual lozenges, patches, creams, and gels can be quite effective and easy to use, with minimal side effects. The benefits they offer may include:

• improved energy and overall well-being
• increased strength and stamina
• enhanced mood and self-esteem
• improved concentration and memory
• enhanced libido and sexual function.

If you decide to pursue hormone therapy, be aware of the differences between conventional hormone therapy and natural hormone supplements. Natural hormones are those that are bio-chemically identical to the hormones found in your body. As such, their effects in the body are the same as the effects of the hormones they are supplementing.

Hormones in some conventional hormone therapy are not identical to human hormones. In addition, most conventional hormone therapies come in just a few standardized doses, which may or may not include the optimum dose for your needs. Bioidentical hormone supplements are often custom compounded, which allows for specific dosing and potency, and tailoring each prescription for each individual’s needs.

With any hormone treatment, it is important to work with your healthcare practitioner to maintain the proper hormone balance. This is especially true if you also use other supplements or herbs, as they may interact with your medications, including hormone treatments.

Andropause: What You Should Know about Male Menopause 2017-12-14T12:36:09+00:00

Book Review – The Edge Effect by Eric R. Braverman, MD

Book Review – The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage by Eric R. Braverman, MD

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


In The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage, Dr. Eric Braverman introduces the notion of a series of “pauses” that occur as we age, such as menopause. Some women experience their first menopause symptoms as young as in their 30s, characterized by dramatic drops in testosterone and progesterone. Estradiol losses may also start in their early 30s. Diminished bone density, less abundant hair, and cognitive dysfunctions accompany the loss of these sex hormones. Andropause (the male equivalent of menopause) typically starts around the mid-40s and continues over the next 30 years with similar effects.

Dr. Braverman points out that our bodies go through many other “pauses” as we age:

  • Up until about the age of 30, bone mass increases or is near optimal. After that, osteopause begins. The availability of proper nutrients in the diet typically starts to be a concern, plus the ability to absorb and make use of those nutrients has also started to decline.
  • During the 30s and 40s, dermopause begins to show with diminished skin thickness, flexibility, or elasticity, all of which are related to the ability to make collagen. The skin also becomes increasingly dehydrated.
  • The maximum heart rate achieved during exercise typically peaks in the 40s, marking the beginning of cardiopause.
  • Along with cardiopause is vasculopause, which is characterized by high blood pressure and diminished blood flow.
  • Thyropause starts generally in the 50s, when the production of thyroid hormone and calcitonin is reduced.
  • Thymopause starts even earlier. The thymus gland aids our immune system by directing the function of T lymphocytes (or T cells). Although this continues life long, the thymus starts to shrink and accumulate fatty tissue at puberty.
  • From the 50s to the 70s there is a marked decline in lung function or pulmonopause. In fact, the effectiveness of breathing is a prime indicator of longevity. Stress, anxiety, and exposure to pollutants negatively affect pulmonary function.
  • Adrenopause, which is characterized by diminished DHEA, can begin as early as the 30s and up through the 60s. By the 70s, without adequate DHEA, cortisol levels also soar. This unhealthy state has earned cortisol the title of “death hormone” because there are so many issues associated with diminished adrenal function. Primary health concerns include changes in focus, memory and attention, depression, lack of energy, loss of libido (especially with women), anxiety, panic attacks, and increased appetite, all symptoms that we readily associate with advanced aging.
  • The loss of muscle mass is another hallmark of aging. By the 90s, 20-40% of muscle mass is lost. This is known as somatopause, and includes reduced muscle strength as well as reduced mental ability.

All of the above are physical “pauses” that typically occur; however, Dr. Braverman and most people believe that the “pauses” related to brain function are even more critical to measuring how well we age:

  • Sensory pause refers to the loss of sensory functions. Hearing starts to decline in the 20s to 40s. The sense of smell starts diminishing in the 40s and more rapidly declines after age 65. Nearsighted increases in the 40s but the ability to see fine details starts to decline in the 70s.
  • Pituitary pause refers to the decline in function of the pituitary and hypothalamus, which are the glands that are masters to the sex hormones, adrenal hormones, thyroid hormones, and more.
  • Electropause refers to the loss of voltage, speed, rhythm and synchrony. For instance, just a 10% drop in voltage can signal signs of depression. With a 90% drop, dementia is a reality.
  • Biopause relates to the brain mediated control of the cascade of all the other pauses.

Other neuropsychiatric disorders can occur at any age but they are especially prevalent in those over 85 years of age, affecting as many as 50% of that population. These types of disorders include cognitive dysfunction and dementia, substance abuse, and personality disorders.

The neurotransmitter hormones Dr. Braverman believes are at the center of delaying the “pauses” are GABA, dopamine, acetylcholine, and serotonin. He correlates the dominance of one or the other of these neurotransmitters to personality types, such as those used in the Myers-Briggs test. His book is brimming with questionnaires to help identify your personality type and neurotransmitter dominance. In addition, he provides guidance as to “bending one’s chemistry the right way” with diet and exercise, as well as supplementing nutrients and bioidentical hormones, and making changes to your lifestyle and/or environment. Further, he invites you to explore how technology can positively affect your brain chemistry.

This litany of “pauses” presents a grim picture of aging. However, Dr. Braverman suggests that there is no reason we can’t slow down their progression. He believes that the brain, and our ability to make and make use of the neurotransmitter hormones in a balanced fashion, is the key to doing so.

  • Braverman ER. The Edge Effect: Achieve Total Health and Longevity with the Balanced Brain Advantage. New York, NY: Sterling Publishing Company, Inc.; 2005.
Book Review – The Edge Effect by Eric R. Braverman, MD 2018-05-02T12:15:55+00:00