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After the age of 40, men experience a phenomenon not unlike women's menopause, termed andropause. In men, there are no clear-cut indicators to define this transition. Both menopause and andropause, however, are characterized by a drop in hormones.

Andropause as a Slow Hormonal Decline

Andropause, the male menopause, is often the real reason for the all-too-common fatigue, declining sex drive, and loss of physical agility men face in middle age. More and more scientific studies find that the decline in testosterone levels caused by andropause puts men at risk for heart disease1 and, like menopause, osteoporosis and weakening bones, even while the male sex organs literally shrink.2

Unlike menopause, which has a clear beginning and end, the decline of the production of testosterone in men is more gradual and takes places over as long as 20 years. There is no diagnostic test to determine which men will experience severe symptoms or when symptoms may occur. The effects of andropause are vague and variable, unique to each man who has them.

One of the most frequent causes of andropause is the accumulation of fat cells, which in both men and women produce estrogen, but as men lose weight and gain weight, estrogen production in fat rises and falls. This is one of the major reasons it is so hard to pinpoint when andropause starts and when it ends.

It's rare, of course, that men consider the possibility that physical changes at mid-life are due to low testosterone. Likewise, doctors often do not run testosterone measurements when they order labs for physicals. But creeping rises in estrogen levels combined with slow declines in testosterone production a variety of physical ills.

Male Menopause Caused by Estrogen Dominance

Men's bodies naturally produce both estrogen and testosterone. The balance between those hormones can be upset by decades of consumption of xenoestrogens, which are chemicals appearing in food and the environment that act in the same way in the human body as estrogen. Common sources of xenoestrogens are chicken, beef, and pork raised by mass production methods that add estrogen-like compounds to the feed to stimulate the animals' weight gain. Xenoestrogens are also found in plastics used for storing juices, sodas, and water, and in styrofoam, cosmetics, solvents, paint, air fresheners, herbicides, and pesticides.

Although the treatment of prostate cancer often involves therapies to deplete a man's body of testosterone, the genesis of prostate cancer often centers on estrogen dominance. The medical literature confirms that men who have excesses of estrogen often have enlarged prostates. Decades of exposure to xenoestrogens stimulates the growth of cells lining the prostate, so that it slowly and painfully diminishes the normal flow of urine. In the lab, prostate cells bathed in estrogen become cancerous, but treating them with testosterone causes the cancerous and precancerous cells to die.
Estrogen dominance does not affect the prostate alone. The testes may produce fewer sperm cells with a corresponding reduction in fertility. Estrogen production by fat enhances the growth of breast tissue, contributes to baldness, and is a frequently overlooked cause of erectile dysfunction. Muscles that do not receive enough testosterone slowly atrophy even while estrogen accelerates the accumulation of facial and upper body fat. Fat cells, unfortunately, contain an enzyme called aromatase that can convert testosterone into estrogen, triggering further activity in the fat cells, destroying even more testosterone. By age 55, andropause and body changes can become a vicious cycle. Distressingly, fat in the buttocks of a male over age 40 destroys testosterone at a rate nearly 1000 per cent higher than fat anywhere else in the body.3

How Men Can Recognize the Signs of Male Menopause

The life-altering effects of male menopause are insidious, but they can be corrected with either testosterone replacement or, in many cases, lifestyle changes. The more "yes" answers a man over the age of 40 gives to these questions, the more likely he is suffering andropause.

  • Are you shorter than you were at age 18?
  • Are your breasts noticeable when you take off your shirt?
  • Are your erections weaker than they used to be?
  • Do you feel drowsy after eating?
  • Do you have problems with intellectual focus and memory?
  • Has your sex drive diminished markedly since age 30?
  • Have you been treated for broken or fractured bones, especially of the wrists or hips?
  • Have you noticed that you need to sleep more even when you are not more active?

Treating the Symptoms of Male Menopause

Men who answer 3 or more of the questions above with a "yes" should get a doctor to run testosterone levels to see if there may be benefits from testosterone replacement. Although testosterone injection is associated with illicit activities of Aspiring weight lifters and major league athletes, it is a legal, safe, and health-restoring therapy when offered by a medical doctor to restore low testosterone levels. Typical criteria for testosterone replacement are:

  • Loss of libido, erectile dysfunction, fatigue, mood swings, insomnia, hot flashes, bone fractures or loss of bone density, loss of motivation, sweating, shrinking of the penis or testicles, and/or decreased beard growth.
  • Ruling out diabetes, malignancy, thyroid dysfunction, liver disease, kidney disease, depression and stress-related conditions as a source of symptoms.
  • Blood test indicating low testosterone level. There are slight differences in measurements at different labs, but generally a low testosterone level is defined as below approximately 240 ng/dl.

If the doctor prescribes testosterone replacement, this likely will be a form of testosterone that cannot be converted back into estrogen by fat tissue. Like estrogen, testosterone can also contribute to the development of prostate cancer, but men with low testosterone levels almost never get the disease. Even so, the doctor will surely require monitoring of prostate health every six months to a year as a requirement for continuing the testosterone prescription. This monitoring will include the digital rectal exam and PSA testing at least three times during the first year of treatment and once or twice a year thereafter.4

Natural Therapies for Male Menopause

Testosterone replacement, of course, is not the only potential treatment for andropause. Simply losing weight often makes a dramatic difference. Men who are morbidly obese and who manage to lose even 10 per cent of their total weight frequently notice stronger erections, renewed growth of facial and body hair, and increased muscle mass without working out. It is important, however, that the weight loss be gradual rather than drastic. Losing weight too quickly depletes testosterone.5

Similarly, while herbal remedies such as bee pollen (the pollen collected by bees rather than any product of the bee itself) and epimedium may stimulate testosterone production, it is more important to stop exposure to xenoestrogens. Laboratory research indicates that effects of exposure to phthalates in plastics and similar chemicals is cumulative, so stopping exposure allows the body to begin to heal.6

Men going through andropause also benefit by choosing meats from animals raised without growth hormones and by avoiding exposure to solvents and aromatic chemicals whenever possible. Men in andropause should not drink green tea, since it activates the aromatase enzyme in fat cells that converts the body's naturally produced testosterone into estrogen.7 Green tea is a drink that is beneficial for men only after they lose weight or before they enter andropause.

  • 1. Kaushik M, Sontineni SP, Hunter C. Cardiovascular disease and androgens: A review. Int J Cardiol. 2009 Nov 16.[Epub ahead of print]
  • 2. Clapauch R, Braga DJ, Marinheiro LP, Buksman S, Schrank Y. Risk of late-onset hypogonadism (andropause) in Brazilian men over 50 years of age with osteoporosis: usefulness of screening questionnaires. Arq Bras Endocrinol Metabol. 2008 Dec, 52(9):1439-47.
  • 3. Vermeulen A, Kaufman JM, Goemaere S, van Pottelberg I. Estradiol in elderly men. Aging Male. 2002 Jun, 5(2):98-102.
  • 4. Bain J. Andropause. Testosterone replacement therapy for aging men. Can Fam Physician. 2001 Jan, 47:91-7.
  • 5. Karila TA, Sarkkinen P, Marttinen M, Seppälä T, Mero A, Tallroth K. Rapid weight loss decreases serum testosterone. Int J Sports Med. 2008 Nov, 29(11):872-7. Epub 2008 May 30.
  • 6. Howdeshell KL, Wilson VS, Furr J, Lambright CR, Rider CV, Blystone CR, Hotchkiss AK, Gray LE Jr. A mixture of five phthalate esters inhibits fetal testicular testosterone production in the sprague-dawley rat in a cumulative, dose-additive manner.Toxicol Sci. 2008 Sep, 105(1):153-65. Epub 2008 Apr 14.
  • 7. Monteiro R, Assunção M, Andrade JP, Neves D, Calhau C, Azevedo I. Chronic green tea consumption decreases body mass, induces aromatase expression, and changes proliferation and apoptosis in adult male rat adipose tissue. J Nutr. 2008 Nov, 138(11):2156-63.