The concept of male menopause has captured headlines for decades, yet clinical science paints a far more nuanced picture of how ageing impacts male hormonal health. While female menopause marks the definitive end of the reproductive cycle, men experience a much slower testosterone level decline over time.
Many researchers instead link these age-related changes to late-onset hypogonadism, a distinct medical issue that affects only a small fraction of the population. Understanding the reality behind androgen decline in ageing males helps clarify whether mid-life symptoms stem from hormonal shifts, lifestyle habits, or underlying health conditions.
Is Male Menopause a Real Medical Diagnosis?
While advancing in age does have effects on the levels of sex-specific hormones in men, relating the process to female menopause is not accurate.
Some researchers instead associate the symptoms with a condition called androgen decline in ageing males (ADAM), or late-onset hypogonadism. This occurs naturally when the gonads, or organs that produce sex cells, begin to age and lose function.
The condition affects only 2.1 per cent of males, while menopause is a natural part of female sexual development. This prevalence increases with age but is still not a standard step in male development.
A doctor will suggest a diagnosis of late-onset hypogonadism when a man demonstrates three sexual symptoms and has androgen levels lower than 11 nanomoles per litre (nmol).
Recognising the Symptoms Behind Male Menopause
Menopause in women marks a sharp drop in oestrogen and progesterone, the main female reproductive hormones, which decline considerably in a relatively short period of time.
The symptoms of conditions that people often label as ‘male menopause’ emerge more slowly and subtly and less severely than in menopause.
The decrease in the levels of male hormone, or *testosterone level decline*, is less severe than the drop in hormone levels for women throughout menopause.
The varied signs and symptoms some people attribute to male menopause include the following:
- Hot flashes
- Moodiness and irritability
- Fat build-up around the abdomen and the chest
- Loss of muscle mass
- Dry, thin skin
- Excessive sweating
A study in the New England Journal of Medicine (NEJM) identifies the most common symptoms of male menopause as decreased libido, a lower frequency of morning erections, and erectile dysfunction.
The study lists other symptoms that include a loss of energy; an inability to walk more than 1 kilometre, or 0.62 miles; and difficulties completing strenuous physical tasks, such as running or lifting heavy objects.
Kneeling, bending, and stooping might also become more difficult. Depression and fatigue might also set in as a result of the change in male hormone levels.
Root Causes of Testosterone Level Decline
After a man reaches the age of 30 years, testosterone levels gradually decrease, falling an average of one per cent each year.
However, doctors do not believe that the normal, age-related decline of testosterone levels is at the centre of male menopause symptoms. Were this related to the symptoms, every man would experience them, which is not the case.
This condition is complex and can produce different symptoms in different people. While these symptoms often occur in older men with declining testosterone levels, they tend to occur in older males with heart disease, obesity, high blood pressure, and type 2 diabetes.
This suggests that changing levels of male hormones are not the sole contributor to this condition. Other risk factors include underlying health problems, such as a lack of exercise, smoking, alcohol consumption, stress, anxiety, and sleep deprivation.
Erectile dysfunction may be the result of changes in the blood vessels or a nerve problem. Some men experience the psychological impact of a “mid-life crisis”, in which they become concerned about professional and personal milestones. This can be a cause of depression, which can trigger a range of factors leading to the physical symptoms of *androgen decline in ageing males*.
Medical Perspectives and Treatment Approaches
One study describes how male menopause became medicalised, not as a result of scientific research but “a model perpetuated by laypeople and medical popularisers.” A physician is not likely to diagnose male menopause. It represents a set of symptoms on which there is little agreement.
Since the condition has no clear definition, men who experience these physical changes will receive treatment according to their symptoms:
- Lifestyle Adjustments: A person with obesity will receive support for weight management and an exercise regimen. Adjusting food intake to engage with a well-balanced and nutritious diet helps ease physical strain.
- Underlying Disease Management: Controlling blood glucose levels reduces symptoms for individuals with diabetes and cardiovascular disease. Doctors perform detailed checks on symptoms like erectile dysfunction and fatigue to catch heart issues early.
- Mental Health Support: Referring an individual with signs of depression or anxiety to a psychologist or psychiatrist provides access to psychotherapy or antidepressants.
- Hormone Therapies: A doctor may recommend testosterone therapy, but the effectiveness of this treatment is not clear. Testosterone therapy might increase the risks of a blockage in the urinary tract and prostate cancer. It may also aggravate ischaemic heart disease, epilepsy, and sleep apnoea.
The FDA ruled in 2015 that many testosterone and vitamin supplements claiming to support *male menopause* often do not contain the advised components and may increase the risk of developing prostate cancer and cardiovascular issues.
Speak to a doctor about managing the symptoms of ageing and age-related disease. Ultimately, maintaining a healthy lifestyle, exercising regularly, and managing underlying health problems remain the most effective ways to support male vitality over time.
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