Does a male menopause exist?
A male menopause genuinely exists, but it proceeds so gradually that many men do not recognise their complaints as hormonal; anyone experiencing fatigue, loss of libido or mood complaints from middle age onwards would do well to discuss this with a doctor, including as a partner.
Yes, something like a 'male menopause' does exist, but it works very differently from the female menopause. From around age 35 to 40, testosterone levels in men decline by roughly 1 to 3 percent per year. This gradual process has been given the names andropause or 'late-onset hypogonadism' and has been established in several studies1,2.
The key difference from the female menopause is that in women the ovaries stop functioning abruptly and completely, whereas in men there is a slow decline that unfolds over decades. Men also remain fertile into old age, although sperm production and sperm quality do gradually decrease2,3.
Some middle-aged men report complaints that resemble those of the female menopause: fatigue, reduced libido and mood changes. An association with the hormonal decline has been demonstrated, but a direct cause-and-effect relationship is still debated3. It is therefore not the case that a lower testosterone value automatically causes complaints.
Lifestyle and work also play a demonstrable role. Psychological stress, heavy physical strain and sleep problems are associated with more severe complaints, as shown by a systematic review of 9 studies4. Stress and illness can furthermore accelerate the age-related decline in testosterone production in the testes, in the so-called Leydig cells2.
A practical point of attention for couples is that both partners may deal with hormonal changes at the same time: the man with andropause, the woman with menopause. This can affect the sexual health of both partners, and treating only one partner may then be insufficient or even counterproductive5,6. Finally, an association has been found between the decline in testosterone and growth hormone and a modest negative effect on skin and wound healing, but this relationship is still associative and has not yet been established as causal7.
The claims are based on a mix of review studies, a systematic review and older primary studies. The evidence for the hormonal decline itself is reasonably solid; the evidence for a direct causal relationship between that decline and complaints is weaker and primarily associative.