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.
Which hormone levels are tested during menopause and what do the results mean?
During menopause, the hormones measured most commonly are FSH, LH, oestradiol, progesterone, testosterone and AMH; elevated FSH combined with reduced oestradiol (below 20 pg/ml) is the most reliable sign that menopause has begun, but always have your results explained by your doctor, as body weight and background influence reference values.
Does my weight and metabolism change during menopause?
During menopause, your body composition changes profoundly: more abdominal fat, less muscle and a lower resting metabolic rate. Exercise and nutrition demonstrably help, and discuss hormone therapy with your doctor as an additional option.
Can you delay menopause with lifestyle or diet?
Avoiding smoking, eating less red meat, and eating more citrus fruit and oily fish appear to have a favourable influence on the age of menopause. However, evidence from controlled experiments is still entirely lacking.
Do men need estrogen for their health?
Yes, men need oestrogen for strong bones, healthy blood vessels, and fertility. Both a deficiency and an excess are harmful, so it is a matter of finding the right balance.
Which supplements actually help with menopause?
Red clover isoflavones and black cohosh have the strongest evidence for reducing hot flashes; soy isoflavones also help to some extent. For bone health, vitamin D is well supported. The effects are modest, and for severe complaints it is best to discuss the options with your doctor.
What complaints are most common during menopause?
The most common menopausal complaints are joint and muscle pain, fatigue and sleep problems; hot flushes are the most characteristic but do not top the prevalence rankings. If you recognise several of these complaints, it is worthwhile discussing them with your GP, who can consider what may help for each one.