April 22, 2011
Dear Mayo Clinic:
Is there a male menopause?
Menopause refers to the end of menstruation and fertility in women. It's caused by a dramatic drop in production of the female hormone estrogen by a woman's ovaries. There is no equivalent in men. So, no, men don't experience a male menopause.
However, men do experience a hormonal change as they get older. Clear evidence indicates that they gradually produce less testosterone, the primary male hormone, throughout adulthood. But, even taking this age-related decline into consideration, the testosterone level of most men stays within what is considered a normal range, and they don't experience signs or symptoms.
If a man's testosterone production drops below normal levels, for example, as the result of using medicine to turn off testosterone production for the treatment of prostate cancer, he can experience symptoms that include hot flashes (similar to hot flashes experienced by women during menopause), fatigue, trouble sleeping, difficulty concentrating and reduced sexual drive and performance. Erectile function may or may not be affected.
The underproduction of testosterone is called hypogonadism. In addition to hormonal therapy inducing this condition, hypogonadism can be inherited or result from a past injury or infection of the testicles, and also can occur with aging.
If you suspect a low testosterone level, see your doctor. In addition to the symptoms described above, the condition can cause a decrease in muscle mass and loss of bone mass (osteoporosis), similar to postmenopausal women. Some men who are diagnosed with hypogonadism can be helped with testosterone replacement therapy, which slows this loss of muscle and improves bone density.
Some people worry about the treatment's potential side effects. They think of anabolic steroid use in athletes, for example, which can cause liver problems and male infertility. But our primary concern with testosterone replacement therapy in older men is prostate growth and prostate cancer, because the prostate gland grows under the influence of testosterone. While there is not a great deal of evidence that patients who receive testosterone replacement therapy are at increased risk of prostate cancer, this possibility is an unresolved issue.
Testosterone replacement therapy can produce other unwanted side effects, however, including the development of obstructive sleep apnea and the overproduction of red blood cells in some men. Because of these risks, it's important that your doctor talks with you about your symptoms, measures your blood cell count, examines your prostate and checks your prostate-specific antigen (PSA) blood level.
In men who are not clearly underproducing testosterone — their levels still register in the normal range — no evidence indicates that supplemental testosterone therapy is helpful. Also, research does not tell us if testosterone therapy improves muscle strength, muscle mass or physical performance measurements.
Your doctor can diagnose underproduction of testosterone with a simple blood test. A sample is usually taken in the morning after fasting and, typically, is measured on more than one occasion because testosterone production can vary slightly from day to day. A diagnosis of hypogonadism is based on the presence of symptoms suggesting low testosterone, and at least two or three abnormally low testosterone blood tests.
— J. Taylor Hays, M.D., General Internal Medicine, Mayo Clinic, Rochester, Minn.