Declining hormone levels are a natural part of aging for both men and women. While women experience a dramatic drop in estrogen and progesterone during menopause, sex hormone levels in men drop more slowly over time.
Some people call the phenomenon “manopause.” But according to Ali Dabaja, M.D., a urologist at Henry Ford Health, the actual term for waning hormone levels among men is “andropause.”
The Hallmark Signs Of Low Testosterone
Testosterone levels in men begin to dip about 1% each year after age 40. This slow drop means most men’s testosterone levels still fall within the normal range well into their 50s.
“We don’t usually test men for low testosterone levels unless they have symptoms or certain risk factors,” explains Dr. Dabaja. “Men who have HIV, or who underwent chemotherapy or radiation for cancer treatment may be at risk of low testosterone, so screening in these populations makes sense.”
In most cases, dips in testosterone levels don’t cause noticeable symptoms. When men do have symptoms, they can be similar to normal signs of aging, medication side effects, obesity or overweight. It can also be due to other medical conditions, like hypothyroidism (underactive thyroid) or diabetes.
Symptoms of low testosterone vary, but many of them are comparable to the symptoms women experience during menopause:
- Difficulty sleeping
- Loss of muscle mass
- Low bone mineral density
- Low energy
- Mood swings
- Poor memory and concentration
- Reduced sexual desire and sexual dysfunction
How And When To Test For Low Testosterone
If you have symptoms of low testosterone, your doctor will perform tests to confirm the diagnosis, including:
Meet With A Urologist
- A physical exam
- Blood tests to measure total testosterone level (usually before 10 a.m.)
- Hormone tests to diagnose the cause of low testosterone
- Additional testing to rule out other medical conditions
“If the patient’s testosterone level is consistently low, the next step is to pinpoint the cause,” Dr. Dabaja says. “Sometimes low testosterone happens because the testicles aren’t functioning to their fullest potential. Other times, the testes aren’t being stimulated with the proper hormones.”
Once doctors identify the cause, they can guide you toward the best treatment options. To ensure you get the most appropriate treatment, your doctor may refer you to a men’s health hormone specialist.
Treatments For Low Testosterone
If you’re diagnosed with low testosterone, you may be a candidate for testosterone replacement therapy (TRT). Like hormone replacement therapy for women, TRT can be delivered in a number of ways, including:
- Daily oral pills
- Transdermal gels, creams and patches
- Long- and short-acting injections
- Nasal spray
- Implantable testosterone pellets (placed in the hip or buttocks) with a three- or six-month supply of TRT
“The goal of treatment is to relieve symptoms by replacing lost testosterone,” Dr. Dabaja says. “But like any therapy, testosterone replacement comes with side effects and may not be appropriate for all men with low testosterone.”
People who have a history of male breast cancer or prostate cancer, and men who are at high risk of heart disease may need to have a conversation with a doctor to figure out if they are good candidates for TRT.
How To Best Navigate Andropause
TRT isn’t the only way to manage andropause. Implementing certain lifestyle changes can also help relieve symptoms.
“There are a lot of options patients can try before starting treatment,” Dr. Dabaja says. A few examples:
- Eat a balanced diet, including plenty of fiber and protein.
- Exercise, particularly weight-bearing exercise that focuses on building muscle mass.
- Maintain a healthy weight.
- Prioritize your mental health.
- See a specialist.
“There are urologists who specialize in men’s health, fertility and sexual medicine who can guide you toward different treatment options,” Dr. Dabaja says. “So if your primary care doctor isn’t familiar with treatment options, getting a referral to a specialist is really important.”
Reviewed by Dr. Ali Dabaja, a urologist who sees patients at Henry Ford Medical Center in Dearborn and at Henry Ford Hospital in Detroit.
