‘Machopause’: Hormonal Changes in Men

Women are not the only ones who suffer from the effects of changing hormones. It can happen to men, too. Andropause, as it is known, is the male version of menopause. Just as estrogen is vital to females, testosterone is vital to the development and normal functioning of males.

If a man is healthy, his hormone production may remain normal into old age, and he may be able to produce sperm well into his eighties or even later. On the other hand, as men get older, starting usually between the ages of 45 and 50, subtle changes in the functioning of their testicles may take place that dramatically reduce their testosterone, with levels of the hormone dropping off more quickly in some men than in others.

Typically, this decrease in male testosterone leads to symptoms of depression, fatigue, and lack of energy. In some men it may decrease their appetite for sex. A decline in testosterone can also put men at risk for heart disease and osteoporosis.

Andropause is more gradual in men than menopause is in women. It may also be accompanied by a variety of psychological effects known as a “mid life crisis,” which is expressed through the purchase of a sports car, for instance, or through leaving their family and finding a younger woman.

However, such behavior cannot be entirely explained by a drop in testosterone—usually there are other factors involved as well.

Though andropause has not been as well described in men as menopause has been in women, it’s real, and it’s clear that men do experience it. However, since the symptoms of depression and fatigue have traditionally been attributed to the aging process, andropause has not been recognized as a clinical problem and is still being debated. Consequently, you won’t find many men going to see their primary care doctor saying, “I think I’m going through male menopause.”

There are now diagnostic tests that can measure the amount of free or bioavailable testosterone in the body. You might think that hormonal replacement therapy for males would be an easy solution to the problem, but it isn’t. Testosterone is a very strong hormone, and high levels of testosterone have been linked to heart disease and prostate cancer; so in the management of andropause, it’s a good idea to look at factors that might influence the natural testosterone level of the individual without having to take in extra testosterone.

One such factor is obesity. If you are excessively overweight, the fat is going to interfere with your testosterone production, especially if that weight gain is the result of what I call the White Diet, which consists of white bread, flour, refined carbohydrates, and sugars. But by losing weight and decreasing your body fat, you can not only reduce your natural estrogen (yes, men have the female hormone in their bodies, just as females have the male hormone testosterone), but increase your natural level of testosterone as well. Many times this is all that is needed to overcome obesity.

Male hormonal therapy is an option for increasing testosterone levels, but it has to be very carefully monitored by an endocrinologist who knows how to prescribe testosterone: it’s not only a question of which testosterone to give but how much to give.

Other medications have been tried with some success, including Clomiphene, a medication that typically has been given to women to improve ovulation. In men, Clomiphene improves the natural levels of male testosterone by reducing their natural level of estrogen.

The best way to cope with andropause is to relieve your stress, eat a nutritious, low-fat, high-fiber diet, get plenty of sleep, exercise regularly, and limit your consumption of alcohol.