Male Menopause: Know the Signs and Treatment Options

Low testosterone might be to blame for a sluggish sex drive, fatigue and erectile dysfunction.

Medically reviewed in June 2021

You're tired and cranky, and your sex drive ain't what it used to be. You may even have some issues with erectile dysfunction. Could you be going through "the change?" Turns out, midlife hormonal fluctuations aren't just a "woman thing." Men can experience menopause, too—in the form of low testosterone (low T).

Though the phrase male menopause—also known as andropause or, as some have dubbed it, "men-opause"—is a bit of a misnomer, the condition is real, says Robert Brannigan, a urologist at Northwestern Memorial Hospital and associate professor of urology at Northwestern University Feinberg School of Medicine.

What is low T?
Whereas women experience a sudden drop in hormones that signals a change in their ability to reproduce, with male menopause the result is a gradual decline in testosterone. Because it happens slowly (over a period of years), the symptoms of male menopause (e.g., fatigue, sluggish sex drive, irritability, depression, muscle loss and erectile dysfunction) may be subtle and hard to detect.

Testosterone levels fall naturally as we age—on average, about 1 percent a year after age 30. That means that by the time you reach 70, your testosterone level may have dropped by half from its peak. Though aging is the main cause of low T, other conditions and medications, such as testicular cancer, a scrotum injury, chemotherapy, radiation treatment and mumps, are all possible culprits.

Is male menopause common?
According to a study in the New England Journal of Medicine, male menopause is relatively rare, affecting only 2 percent of men over 40. Other stats show that 5 percent of all men (and nearly 20 percent after age 70) suffer from low T. However, urologists, such as Steven Kaplan, director of the Iris Cantor Men's Health Center at NewYork-Presbyterian/Weill Cornell Medical Center, argue that numbers don't tell the whole story.

"To some degree, most men experience some manifestation of [male menopause] in the sense that, as we age, we're not the same in our 50s or 60s as we were in our 20s," Kaplan says. "There are a lot of different reasons for that, but hormonal balance is a piece of that. Some men are bothered by it and experience symptoms, and others are not."

While the New England Journal of Medicine study defined male menopause as low testosterone plus at least three sexual symptoms (e.g., erectile dysfunction, poor morning erection, low desire), Brannigan says symptoms can manifest themselves differently depending on the patient. "At the end of the day, every patient is individual and unique," he says. "If his testosterone level is low and he has symptoms, we treat it. We don't insist that he have ED."

If your sex drive has taken a nosedive, your apparatus isn't working the way it used to, your muscles have gone flabby, or you have no energy, you may want to have your testosterone levels checked with a blood test. Normal testosterone levels range between 300 to 1,200 ng/dl. Brannigan recommends testosterone replacement therapy for men with levels below 300.

"It's not a panacea, and I don't believe in wholesale screening of everyone, but I do believe there is a place for it," Brannigan says. "It's not the fountain of youth, but if you're suffering from low T, hormone replacement therapy may restore some of the pep that you're accustomed to.

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