Is there such a thing as male menopause?

In men, in contrast to women, there is still a great deal of uncertainty about the connections between ageing and hormones. The effects of low hormone levels on the body and the psyche have not yet been fully investigated. However, hormones play an essential role in the physical and mental well-being of men. Even today, science is powerless against ageing. There are many things that can be done against complaints caused by a hormone deficiency.
In women, the menopause begins around the age of 50. A decrease in hormone production in the ovaries within a few years leads to the absence of menstruation and the end of the ability to conceive. However, the menopause is also accompanied by a variety of psychological and other physical symptoms.
There is no such thing as the menopause in men. The term „male“ menopause should therefore not be used. The condition of proven hormone deficiency is now usually referred to as „hypogonadism“. In the context of the ageing man, the term „PADAM = Partial androgen deficit of the ageing man“ has become established. The hormone production of the testicles slowly and steadily decreases from about the age of 35. On average, the free (biologically active) testosterone decreases by about 1.2 % per year. The ability to procreate also steadily decreases. This decrease in hormone production is accompanied by typical symptoms that are often not recognised and treated in time or not clearly as the result of a hormone deficiency. However, the ageing process is not only due to a hormone deficiency.

What complaints are observed?

With increasing age, men begin to experience complaints that are typical of old age. These can be harmless, but can also lead to serious illnesses of body and soul. In addition to external changes in skin and hair growth, age can also lead to serious changes such as high blood pressure and lipometabolic disorders. Cardiovascular problems, increased blood sugar levels or problems with urination often occur for the first time. Typical changes associated with a reduced production of male hormones are:

• Decrease in sexual desire (libido)
• Decrease in erectile function
• Regression of body and pubic hair
• Decline in performance, tiredness, sleep disturbances
• Hot flushes
• Increasing bone fragility (osteoporosis)
• Decrease in skin thickness (wrinkles, pigmentation spots)
• Tendency to depressive moods (restlessness, anxiety, nervousness, increased irritability, feelings of inferiority)
• Decrease in musculature
• Increase in fatty tissue, especially in the abdominal area
• Anaemia with reduced formation of red blood cells (anaemia)
• Reduction in the size of the testicles
• Loss of reproductive ability

These and many other complaints can occur with increasing age. In individual cases, they can be so severe that they lead to a significant reduction in quality of life. However, there are also men who have no complaints.

When do the complaints start?

The testicles and also the adrenal glands of the man do not suddenly stop hormone production as in the woman. Therefore, there is no defined period of time with an acute hormone deficiency in men. Already at the age of 30 – 35 years, hormone production in men gradually decreases. The average hormone level of free testosterone in the blood of a 70-year-old is only 1/3 of that of a young man. However, there are also large individual differences.
A number of men are physically fit and sexually active into old age. Others already show physical complaints at a younger age, which can be traced back to a hormone deficiency. Most of those affected report the complaints between the ages of 45 and 65. However, it is not clear which of these complaints are really due to a hormone deficiency.

Wie kann man die Beschwerden lindern?

Treten solche Beschwerden in Zusammenhang mit einem Testosteronmangel im Blut auf, ist die logische Schlussfolgerung, das fehlende Hormon zu ersetzen und von außen zuzuführen. Liegt kein nachgewiesener Hormonmangel vor, sollten Sie mit ihrem Arzt andere Ursachen dieser Beschwerden ausschließen und entsprechend behandeln.

How does the male hormone work?
The most important male hormone, testosterone, is formed to 95 % in the testicles and to 5 % in the adrenal glands. The production of testosterone is regulated by hormones in the diencephalon (hypothalamus) and the pituitary gland (hypophysis). Testosterone production is subject to a diurnal rhythm. The highest testosterone levels are found in the blood in the early morning hours (approx. 5.00 – 7.00 a.m.), after which the level continues to fall throughout the afternoon and evening until it reaches its lowest values at night. With increasing age, this circadian rhythm is lost. Testosterone is predominantly present in the body in a bound, biologically non-effective form. Dieser gebundene Teil steigt mit zunehmendem Alter an. In some organs, testosterone must first be converted in order to be effective. With increasing age and fat tissue, testosterone is increasingly converted into the effective female hormone oestradiol.
Hormones affect almost all cells of the body, as do the sex hormones. They act both via certain structures on the surface of the cell and directly in the cell. They are just as important in human development (e.g. puberty) as they are for the physical and psychological well-being of adults.
Important for a balanced hormone balance in men is the equilibrium between total testosterone, its free and thus biologically effective portion, and the relationship to other hormones.

How is a hormone deficiency in men diagnosed?
Treatment with the male hormone testosterone should never be started on the basis of symptoms alone. The body’s own production of testosterone in the blood must always be examined at the same time. If the body’s own hormone production is normal, further examinations should clarify the cause of the symptoms. A hormone deficiency can be detected by determining the amount of testosterone in the blood. Because of possible diurnal fluctuations, the blood sample should be taken in the early morning if possible. If a level below the normal range is found during a single examination, a control examination should be carried out in any case.

Do men also need hormones in old age?
Not all complaints of old age are related to a hormone deficiency. Many other causes, such as illnesses and medication, but also psychological and social influences, such as changes in the partnership, loss of employment and retirement can lead to similar complaints. Unfortunately, it is not possible to determine in each individual case which of all the influences play the biggest role.
Men therefore do not need hormones in every case, but only when a deficiency of male hormone is objectively proven in existing complaints.

What can testosterone not do?
Testosterone cannot stop the natural process of ageing. However, it can reduce complaints in advancing age that are due to a lowered blood level. Taking testosterone to increase performance (doping) is strongly discouraged. This leads to testosterone levels in the blood that are several times higher than the norm, which can damage the body in the long term.

Which hormones should be replaced?
Only hormones that are missing should be replaced. In men, this is primarily the male sex hormone testosterone. Only your doctor can decide together with you which active substance and which form of administration is best for you. The aim of hormone replacement therapy is to restore normal hormone levels. In rare cases, it may be necessary to add other hormones (oestrogen, cortisol or growth hormones). It is important to restore hormonal balance through individually tailored hormone replacement therapy so that you feel as fit and able to perform as you used to in earlier years. There has not yet been sufficient scientific research on the use of DHEA (dihydroepiandrosterone) or DHEA-S (-sulphate). This is also due to the fact that DHEA is offered as a food supplement in the U.S. and therefore does not have to meet the strict requirements of the American health authorities. In Germany, DHEA is a prescription drug. So far, there is no indication for oestrogen substitution in men.

How should the hormone be replaced?
Testosterone can be supplied in different ways. It is important to know that when testosterone is absorbed through the gastrointestinal tract, the hormone loses most of its effectiveness. Therefore, it makes sense to supply testosterone via other routes. One effective option is the administration of slow-release testosterone (testosterone antate) in the form of intramuscular depot injections. These testosterone depot preparations are administered every two to four weeks. This depends on the personal need, which is determined on the basis of complaints and the testosterone level in the blood. This type of treatment is relatively inexpensive. Drugs that release testosterone even more slowly (testosterone bucciclate) are being developed, so that the injection intervals can also be extended up to 3 – 6 months. Testosterone can also be administered through the skin. In the past, there were different forms of patches that were applied to different parts of the body (trunk, extremities, scrotum). However, allergic reactions and difficulties with handling prevented widespread acceptance.
The breakthrough in hormone replacement therapy for men has been testosterone gels or testosterone ointments. Patients apply the gel or ointment in the early hours of the morning to areas of the body with as little or no hair as possible. The gel in particular is absorbed very quickly into the skin. The use of micronised testosterone (very small crystals) results in rapid absorption through the skin. A sufficient active level is built up within 1 to 2 days. Depending on the dose used (25, 50 or 100 mg testosterone gel), this application can restore sufficient levels for all cases of testosterone deficiency.

Who should not receive male hormones?
Testosterone replacement therapy is not intended to promote muscle mass or physical performance in healthy individuals. Testosterone treatment should not be given for malignant tumours of the prostate or breast. In benign prostate enlargement with significant obstructive micturition problems, testosterone treatment should be limited as it may worsen the micturition problems. In patients with severe cardiovascular diseases, severe high blood pressure, migraine, a seizure disorder (epilepsy) or sleep apnoea syndrome, testosterone should only be used after a strict risk-benefit assessment by the attending physician and under close monitoring.

What side effects can occur with testosterone treatment?
Testosterone should only be administered if there is a proven deficiency. Dosages should be chosen that normalise the blood level. Under such treatment, side effects occur only in very rare cases.
Increased water retention or swelling of the mammary glands (gynaecomastia) may occur. Very rarely, painful permanent erections have been described. Testosterone treatment leads to a reduction in sperm production in the testicles and a reduction in the size of the testicles. These changes disappear within a few months of stopping testosterone treatment. With long-term use, there may be an increase in red blood pigment in the blood (polyglobulia), which can lead to a deterioration in the blood’s flow properties. Increased blood pressure (arterial hypertension) has been reported in some patients during treatment. Rarely, diarrhoea may occur.
When a gel or ointment is applied, local skin changes such as redness, acne or dry skin may occur in up to 10% of all patients. Existing prostate cancer and benign prostatic hyperplasia (BPH) may be stimulated to grow by testosterone.

What controls should be carried out during hormone replacement therapy?
It is important that treatment with testosterone is not started solely because of age-related complaints. Treatment should only be initiated if there is evidence of decreased levels of total testosterone or its effective free form in the blood. Thus, the symptoms and the testosterone blood levels are indications for adequate testosterone replacement treatment.
Under testosterone replacement treatment, blood values should be checked regularly. In particular, liver function values, fasting blood lipids and red blood cell counts should be checked.
Furthermore, it is important that the treated man has regular screening examinations. Prostate carcinoma is the most common malignant tumour in men. The development of prostate carcinoma is not promoted by testosterone, but this tumour can grow more quickly under significantly increased testosterone levels. It must therefore be ruled out by a PSA value determination and a rectal examination before starting therapy.

What can you do yourself?
There are a number of factors that negatively influence the effect and formation of the male hormone. Numerous medications, obesity, long-term fasting, drugs and alcohol as well as psychological and physical stress can lead to an increased decrease in hormone levels. Serious infections and other chronic diseases are also frequent causes of hormone imbalance in men. The amount of male hormone depends to a certain extent on the age-related changes in the testicles, but the factors listed above can also have a negative influence on the formation or effect.
A healthy and balanced diet, avoiding alcohol and nicotine, as well as mental and physical training can help to keep one healthy.

Healthy men have higher testosterone levels.
When men start to get active, eat a healthy diet, get enough exercise and strive to stay physically and mentally fit, the first step is taken. A hormone deficiency or imbalance is easy to correct, but it must be recognised. Therefore, it is necessary to see your doctor and talk about your problems. Only then can your problem be recognised and treated.

Abdominal circumference
The abdominal circumference can be used to estimate how much fat is present in the abdomen. „Life rings“ around the middle of the body are not only an aesthetic problem, but also a serious health risk. This is because the cells in the abdominal fat form substances that constrict the blood vessels and severely disrupt the metabolism.
In addition, men with a large abdominal girth are very likely to have a testosterone deficiency, which can lead to symptoms such as chronic fatigue, listlessness and potency problems. Testosterone therapy can eliminate these symptoms and reduce abdominal fat.

Why is abdominal circumference so important?
Abdominal circumference is a measure of the amount of fat in the abdomen. The larger the abdominal circumference, the lower the testosterone blood level in men. Men with an abdominal circumference over 102 cm are likely to have a testosterone blood level below normal.
A testosterone deficiency can lead to complaints such as potency problems, less desire for a partner, listlessness, frequent heavy sweating, chronic fatigue and a decrease in strength.

Big belly and testosterone deficiency
A fat belly and complaints of testosterone deficiency do not correspond to the ideal male image. But that is by no means all! Belly fat is a „hormone factory“. It produces substances that lead to inflammation in the blood vessels and cause them to constrict. This can lead to high blood pressure and increase the risk of heart attacks and strokes. The substances disrupt the fat, sugar and insulin metabolism, and so-called adult-onset diabetes (diabetes mellitus type 2) can develop.
Scientific studies have shown that an abdominal girth over 102 cm in men is associated with an increased risk of cardiovascular disease and diabetes, as well as low testosterone levels.

Measure abdominal circumference correctly
The right time to measure your abdominal circumference is in the morning before breakfast, undressed in front of the mirror. The correct height is where the abdominal circumference is greatest. For most men, this is about halfway between the iliac crest and the costal arch (at about navel height). Make a note of this individual spot.
Relax the abdomen and measure the circumference in the middle position, i.e. neither pull in the abdomen nor tighten the tape measure. The tape should rest on the abdomen.

Abdomen circumference in cm

69 to 94: Great!
94 to 102: Attention!

102: Stop! Risk!
Reduce belly circumference
When you have a fat belly, uncontrolled substances are formed in the fat cells that interfere with the normal control of appetite and hunger. Excessive food intake occurs because the feeling of satiety does not set in. This causes further weight gain, and the accumulation of fat – especially in the abdominal area – increases. A vicious circle!

Testosterone normalises the feeling of satiety
Testosterone can help break out of this vicious circle. The sex hormone normalises the metabolism in the fat cells and thus normalises the feeling of satiety. The body composition changes: the fat-free body mass increases, the fat mass – including belly fat – decreases. Testosterone deficiency symptoms improve and you become more active.