Manopause & Low Testosterone: What Every Man and Woman Should Know

By Jed Diamond, PhD, LCSW

When I first began research for my book on the “male change of life,” I wasn’t sure what I should call it. I assumed that what men went through was totally different than what women experienced. But the more I talked to men and women, the more it became clear that there were more similarities than differences. Andropause is the more technically correct term, but Male Menopause has come to be commonly used.

According to Mosby’s Medical Dictionary, 8th Edition, “Andropause is a change of life for males that may be expressed in terms of a career change, divorce, or reordering of life. It is associated with a decline in androgen levels that occurs in men during their late 40s or early 50s. Compare menopause.”

Ultimately I decided to call my book, Male Menopause even though the term is obviously technically inaccurate. The term “menopause,” introduced by French doctors in the 1870s, combines two Greek words—menses (“periods”) and pausis (“stop”). Men don’t have a period, so they don’t stop having one.

Based on my research I concluded that “Male Menopause (or Manopause for short) begins with hormonal, physiological, and chemical changes that occur in all men generally between the ages of forty and fifty-five. These changes affect all aspects of a man’s life. Male Menopause is, thus, a physical condition with psychological, interpersonal, social, and spiritual dimensions.”

Jonathan V. Wright, M.D. and Lane Lenard, Ph.D., authors of Maximize Your Vitality and Potency, say “Although the idea has been around in one form or another for thousands of years, until very recently the existence of a hormonally driven male menopause analogous to that experienced by women was widely denied by the forces that rule mainstream medicine. Officially in this country, it still does not exist, although incontrovertible scientific evidence to the contrary has finally begun a slow shift in attitude.”

Common Signs and Symptoms of Manopause

After working with more than 60,000 men and their partners who were experiencing the Manopause, I detailed the most common signs and symptoms including the following:

*Reduced libido or sex drive.

*Reduced potency or ability to obtain and maintain an erection.

*Fatigue or loss of vitality.

*Irritability and grumpiness.

*Aches, pains, and stiffness in joints.

*Depression that often manifests as anger or boredom.

*Night sweats or “hot flashes.”

*Dryness and thinning of the skin.

*Restlessness and longing to break free.

*Weight gain, especially around the waist.

Manopause, Low Testosterone, and Testosterone Replacement Therapy (TRT)

Hypogonadism is a clinical condition in which low levels of serum testosterone are found in association with specific signs and symptoms. When hypogonadism occurs in an older man, the condition is often called andropause or androgen deficiency of the aging male (ADAM).

Controversy remains regarding indications for testosterone supplementation in aging men due to lack of large-scale, long-term studies assessing the benefits and risks of testosterone-replacement therapy in men. Numerous studies indicate that TRT may produce a wide range of benefits for men with true hypogonadism that includes the following.

*Improvement in libido and sexual function.

*Increased bone density, muscle mass, body composition.

*Improved mood, cognition, quality of life.

*Prevention of cardiovascular disease.

Perhaps the most controversial area is the issue of risk, especially possible stimulation of prostate cancer by testosterone, even though no evidence to support this risk exists. Other possible risks include worsening symptoms of benign prostatic hypertrophy (enlarged prostate), liver toxicity, worsening of untreated sleep apnea or severe heart failure.

Despite this controversy, testosterone supplementation in the United States has increased substantially over the past several years.

Beware of Big Pharma Hype

Kendall Powell, writing in the Washington Post, cautions us about the direct-to-consumer advertising we are seeing that focuses on aging men. “In case you haven’t noticed, advertisements aimed at treating low levels of testosterone, or ‘low T,’ have displaced those erectile dysfunction commercials with side-by-side bathtubs. The ads ask: Are you suffering from any of the following — depression, low energy, weight gain, fatigue, low sex drive? Really, at midlife, who isn’t?”

These drugs, which require a prescription, treat hypogonadism, or low testosterone production. While doctors agree that testosterone therapy is beneficial in hypogonadal men, they are concerned about rejuvenation clinics and Internet sites that push testosterone — or supplements dubiously claimed to boost it — as a cure-all for aging symptoms.

More men than ever are asking their doctors about the newer testosterone products. One study published showed that between 2001 and 2011, testosterone prescriptions for men age 40 and older more than tripled, with the topical gels being the most popular form and men in their 40s the fastest-growing group of users. The report also found that more than a quarter of men prescribed testosterone had not had their levels of the hormone checked before they were given a prescription.

Replacement testosterone therapy in men 40 years and older who have low levels of natural hormone “is legitimate, when done legitimately,” says John Morley, an endocrinologist at St. Louis University School of Medicine. But, he contends, giving testosterone to men with normal levels of the hormone, especially over the long term, holds unknown risks.

Jed Diamond, PhD, MCSW, is the Founder and Director of the MenAlive, a health program that helps men live long and well. Though focused on men’s health, MenAliveis also for women who care about the health of the men in their lives. Diamond’s book, MenAlive: Stop Killer Stress with Simple Energy Healing Tools, brings together the wisdom accumulated in 40 years helping more than 20,000 men, women, and children.