Our bodies naturally undergo hormonal changes as we get older. In the case of women, this is marked by entering perimenopause, a natural biological phase that’s characterised by a decline in oestrogen levels. As most of us know by now, it can cause a number of tell-tale symptoms like hot flushes and sleepless nights.

Recently though, you might have come across the term ‘male menopause’ in the media, a phrase that’s sometimes used to describe a range of hormonal symptoms and shifts that can occur in men in their 40s and beyond.

Also known as ‘andropause’, this concept is becoming more widely talked about in health circles and online. But it’s not exactly the same as menopause in women, and comparing the two life stages can be misleading. We asked Hamid Abboudi, a consultant urologist at New Victoria Hospital, to explain more…

What happens to testosterone as men age?

As the primary male sex hormone, testosterone plays a major role in emotional and physical wellbeing. It’s produced in the testicles and contributes to lots of different daily functions, like sperm production, muscle and bone strength maintenance, sexual function and regulation of body fat distribution.

As men go through life, Abboudi explains that men experience subtle hormonal shifts, marked by a slow decline in testosterone levels. “This decline is a natural part of the ageing process, and it typically occurs more gradually than the abrupt hormonal changes that women experience during perimenopause.” Studies have found that on average, men’s levels of testosterone drop by about 1% per year after the age of 30.

Abboudi believes that the terms ‘andropause’ and ‘male menopause’ can be misleading. “Because of their female counterpart, the terms imply an inevitability about the condition and the fate of the male body. However, the ‘male menopause’ doesn’t happen to every man – in fact, it’s fairly uncommon.

“According to large European population-based studies, the percentage of men experiencing symptoms due to low testosterone is relatively low, typically ranging from 2 to 6%.” By contrast, almost 75% of perimenopausal women experience symptoms.

He also highlights another key difference from the female menopause: “With menopause, there’s an inevitability about a woman’s reproductive potential, whereas with andropause, a man can still conceive in their 40s, 50s, and 60s, even if they’ve got low testosterone levels.”

What is testosterone deficiency?

In some instances, the symptoms of male menopause can be attributed to testosterone deficiency, also known as hypogonadism. This condition arises when the testes become less efficient at producing hormones or even cease production altogether.

Hypogonadism can manifest at any age, but it becomes more likely as men age. The symptoms are diverse and can include increased bone fragility, diminished muscle mass and strength, reduced body hair growth, hot flushes and sweats.

Men might also experience diminished libido, erectile dysfunction, infertility and increased body fat. There can be emotional challenges too, like low self-esteem and mood swings, as well as fatigue, poor concentration, memory issues, increased body fat, and sleep disturbances.

Could the symptoms of andropause be down to something else?

According to Abboudi, andropause can sometimes be mistaken for other medical conditions or issues. “Men in their 40s and 50s might report some of the ‘classic’ symptoms we’ve already mentioned, like fatigue, low mood, and a lack of enjoyment in their usual hobbies.

“This cluster of symptoms is frequently mislabeled as the male menopause, but they’re quite common with age and often have nothing to do with testosterone. Often, there are other underlying health issues at play.

“For example, erectile dysfunction and reduced libido are often signs of cardiovascular disease or diabetes,” Abboudi clarifies. “The symptoms of andropause, such as mood swings, fatigue, and decreased energy levels, can overlap with those of depression.” Also, stress and anxiety can also lead to symptoms like sleep disturbances, irritability, and mood swings.

What treatment is available for the andropause?

If you’re experiencing andropause symptoms, Abboudi urges that it’s important to get them checked out by your GP. A diagnosis of hypogonadism can usually be made based on your symptoms and the results of blood tests used to measure your testosterone levels.

“When it comes to treatment, we’ll usually we’ll try to address any background issues first, usually around diet, lifestyle and stress management.” Maintaining a healthy weight, nixing alcohol, staying active and getting good quality sleep can all help to increase your testosterone levels naturally. “If those things fail, then the patient might benefit from testosterone therapy,” says Abboudi.

Testosterone therapy, also known as testosterone replacement therapy (TRT), is a hormone replacement treatment designed to raise testosterone levels. The therapy can take various forms, including injections, where testosterone is directly injected into the muscle every one to two weeks, and transdermal patches or gels applied daily for a gradual release into the bloodstream.

TRT can also be administered through topical creams absorbed through the skin, buccal tablets placed in the mouth for controlled release, and implants, which involve surgically implanting testosterone pellets under the skin, ensuring a consistent hormone release over several months.

Abboudi says that testosterone therapy can have unwanted side effects, and the long-term risks and benefits aren’t known, so it’s essential to chat through this option with an endocrinologist. For those who have low testosterone levels but no symptoms, this type of treatment isn’t really recommended, because of the unknown risks. As with any medical treatment, the decision on whether the possible benefits outweigh any risks is up to you and your doctor.