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John Whyte, M.D., MPH

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Male Menopause: The Effects of Dwindling Testosterone

Posted: 10/25/10 10:31 AM ET

Have you been moody lately? Or maybe you've lost interest in sex? Do you feel weak and tired a lot?

You might be thinking these questions are geared towards women, but if you are a male and experiencing these symptoms, you might be going through male menopause.

In recent years, we've started to learn that many men often experience some of the same type of symptoms women do as they reach their 40s to 50s. In men, it may be due to low testosterone.

I realize that a lot of men, and some doctors, don't like the term "male menopause." And I agree it doesn't describe the problem very well and probably discourages a lot of men from discussing their symptoms. After all, what male would want to have a condition that affects women?

Even though "menopause" includes the word "men," it actually means permanent cessation of the menses. So no matter how catchy the phrase "male menopause" might be, if you're not a woman, you can't go through menopause!

There's another reason why "male menopause" isn't a very useful term, and that's because it's misleading. The hormonal changes that are associated with menopause in women happen fairly quickly. Once the processes surrounding a woman's menopause are complete, there are no more menstrual periods and certain hormone levels are significantly and permanently changed. In men, the decrease in testosterone is usually gradual, happening over decades. There usually isn't one particular period of time when a man can say "I'm going through the change" -- or a time when he can say, "OK, that was it, my change of life is now over."

Despite what we call it, these changes in men do occur. Therefore, it might be useful to check a testosterone level, especially if you're having any of the following symptoms:

  1. Reduced libido
  2. Decreased erections
  3. Development of breast tissue
  4. Decreased body hair
  5. Small or shrinking testes
  6. Low sperm count
  7. Decreased energy, loss of motivation, low initiative or low self-confidence
  8. Depressed or "blue" mood
  9. Poor concentration or problems with memory
  10. Problems with sleep
  11. Anemia (low red blood count)
  12. A decrease in muscle strength or bulk
  13. An increase in body fat
  14. A decrease in performance at work or in physical tasks


There are some estimates that as many as 20 percent of men with erectile dysfunction have a testosterone deficiency. Medications like Viagra and Levitra don't work in those situations, and if you're currently taking those medicines and not having erections, it might be because of low testosterone.

It's important for me to note that low testosterone is not the only reason why you could have some of these symptoms I mentioned, but many doctors often overlook measuring testosterone. So you may need to bring it up and ask for it yourself.

And be sure to talk to your doctor about the time of day the test is done. Testosterone levels change over the course of the day, so experts often recommend checking testosterone in the morning to get the most consistent and appropriate measurement.

There's no magic cutoff point as to what's normal and what's not in terms of the levels. There's a very big range. But if you do have low testosterone or are on the low side of normal with symptoms, then the best way to see if testosterone works is to try it and see if symptoms improve.

If you and your doctor decide that you could benefit from testosterone supplementation, there are several options. There are testosterone patches, gels you rub into your skin, injections and there is even a sort of pill that you tuck up against your gums. Your doctor can help you decide which one is the best choice for your lifestyle.

The safety of long term testosterone supplementation isn't known. So just like with hormone replacement for women, we aim for the smallest dose for the shortest period of time. You'll also need some blood tests while you're on it to avoid any potentially harmful side effects. As with any medication, there are potential risks. The use of testosterone may increase the risk of prostate cancer, so be sure to have your doctor monitor your risk.

By the way, one reason not to use testosterone supplements is if you want to improve your fertility. Because of how testosterone works in the body, they'll actually have the opposite effect!