Menopause is a term most people are familiar with. But what happens to men as they get older? Often described as ‘andropause’, the gradual decline in testosterone has been compared with menopause. The comparison sounds simple, but medically, the two are quite different.

So, is andropause really the male version of menopause?

To understand more about andropause and the changes men may experience, we spoke to Dr. Aarthi Devi.V, Consultant Endocrinologist at Sugar And Heart Clinic, Hyderabad.

What exactly is andropause, and how is it different from menopause?

“‘Andras’ in Greek means human male and ‘pause’ in Greek a cessation; so literally ‘andropause’ is defined as a syndrome associated with a decrease in sexual satisfaction or a decline in a feeling of general well-being with low levels of testosterone in aging men.

In contrast to menopause, which is a universal, well characterised, timed process where the ovaries reach the natural end of reproductive function around population specific mean age, andropause is characterised by gradual onset and slow progression.”

Does every man go through andropause, or does it affect some men more than others?

“Though there is a decline in testosterone levels in aging men, other factors too augment the rate of decline. Obesity, poorly controlled type 2 diabetes and metabolic syndrome are the top 3 risk factors.

The rate of decline in testosterone levels varies in different individuals and is affected by chronic disease, such as obesity, illness, serious emotional stress, and medications; and this decline can be decelerated by weight loss and healthy lifestyle measures like balanced diet, adequate sleep, stress control and physical activity.

Amongst obesity parameters, waist circumference is one of potentially modifiable risk factors for low testosterone and symptomatic androgen deficiency.”

At what age do men usually start noticing changes in their testosterone levels?

“Circulating levels of testosterone begin to decline in early adulthood. Studies demonstrate that the age specific rate of decline in total testosterone levels ranges up to 0.85 percent/year in men aged 24 to 46 years; 1.6 percent/year in men aged 40 to 70 years and up to 2.6 percent/year in men older than 70 years.

In addition, other chronic conditions that alter SHBG (sex hormone binding globulin – the protein that binds with testosterone and transports it) can also have an impact.”

Why do doctors prefer the term ‘late-onset hypogonadism’ instead of andropause?

“Doctors prefer ‘late onset hypogonadism’ specifically as it implies clinically significant testosterone deficiency, which means there must be symptoms plus consistently low testosterone levels for diagnosis.

It avoids suggesting that every ageing man will develop a hormonal disorder.”

At what age do these hormone changes become noticeable?

“Though there is an insidious age related decline starting from the third decade, it might not be clinically apparent in all men.

The testosterone threshold at which symptoms become manifest varies from person to person, and many men are not symptomatic despite having low testosterone levels.”

What are the most common noticeable symptoms?

“The most associated symptom is low libido.

Other manifestations of hypogonadism include: erectile dysfunction, decreased muscle mass and strength, increased body fat, decreased bone mineral density and osteoporosis, and decreased vitality and depressed mood.

None of these symptoms are specific to the low androgen state, but may raise suspicion of testosterone deficiency. One or more of these symptoms must be corroborated with a low serum testosterone level.

Results from major study – the EMAS proposed, that the presence of three sexual symptoms (decreased libido, morning erections, and erectile dysfunction) combined with a total testosterone level of less than 11 nmol/l and a free testosterone level of less than 220 pmol/l, can be considered the minimum criteria for the diagnosis of LOH in aging men.”

What is the biggest myth about andropause that you would want men not to believe?

“Myth: Age-related low testosterone is always permanent.

Fact: When low testosterone is related to reversible factors such as obesity or metabolic disease, addressing the underlying cause can sometimes improve testosterone levels without lifelong hormone therapy. Healthy lifestyle with reduction in waist circumference plays wonders.”