Madeeha Syed

What happens when male fertility dips? Andropause is increasingly becoming a commonplace phrase to describe a natural male aging process. What is it?

Andropause: The Male Menopause

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Men experience andropause just like women experience menopause. The decrease in hormones may lead to infertility. Andropause treatment can include testosterone booster along with lifestyle changes.

Overview

What is Andropause? Andropause implies a sudden steep physiologic decline in male sex hormones that may lead to physical and mental changes, akin to menopause.&nbsp;

Simply put, yes, men may experience many of the same symptoms that women do during <a href="https://merisehat.pk/disease/menopause">menopause</a>, and that too at the same age, but it has nothing to do with suddenly declining hormone levels.&nbsp;

Nonetheless, that clarification does little to help those suffering from these issues. Our goal moving forward will be to understand the actual cause of these problems and, by providing insight, allow concerned individuals to seek help in the right direction.&nbsp;&nbsp;

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Understanding The Male Menopause

In Greek, andras means male, and pause means to cease. Recent rhetoric has medicalised the term and implied it to be reflective of menopause, so let&rsquo;s begin there:&nbsp;

Menopause is an established and clinically diagnosable medical development that occurs in women, commonly during the ages of 40-55. The etiology of it is a well-researched sudden physiologic (normal) drop in many &ldquo;female&rdquo; hormones (oestrogens) that serve to normally regulate fertility. This decline leads to the sudden cessation of menses and manifests as a host of physical and psychological symptoms.&nbsp;

By naming a similar collection of male symptomologies as Andropause, it implies congruence in the cause, while that is not the case.&nbsp; 
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In men, yes, testosterone levels do physiologically fall, but they do so at a remarkably slow and steady rate, approximately 2 percent per year to be precise. Current literature asserts that this is not responsible for any symptoms commonly termed &quot;Andropause&rdquo;.&nbsp;

Note, that so far, we are discussing only the normal (physiologic) processes, not disease (pathologic) processes.&nbsp;

This is important to distinguish, because a clinical entity known as Late-Onset Hypogonadism, which is associated with a precipitous decline in male sex hormones, and does directly cause symptoms, may have been what led to the birth of the unhelpful term of Andropause. Late-Onset Hypogonadism is an uncommon disease process, it is not the same as normal ageing in men, and has nothing to do with the symptoms men normally undergo with ageing.&nbsp;

To summarise, so far, the vast majority of normal ageing, healthy men, do experience symptoms at age 40-50, and while they may be similar to females undergoing menopause, the cause, is not the same. 
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As anticlimactic as it may seem, the real cause of the unpleasant mental and physical symptoms in middle-aged men, is simply a collection of lifestyle factors of psychological problems, which all by chance tend to unveil themselves together at the same time. Let&rsquo;s break apart the causes, and extrapolate from them the symptoms they can cause:

Underlying psychological stressors, for example, depression, anxiety, or simply stress, tend to peak at middle age in men, climaxing often as a prototypical &ldquo;midlife crisis&rdquo;. These may lead to common mental concerns associated with Andropause, like mood swings and irritability, lack of energy, lack of motivation, sleep and eating changes, loss of libido and even erectile dysfunction. 
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Normal age-related changes to body structure or function, for example, changes to blood vessels, alteration of hormonal signalling, and numerous other minutiae may lead to changes in muscle mass, fat redistribution, gynecomastia or &ldquo;male breasts&rdquo;, decreased exercise tolerance and again, contribute to sexual issues.

Lifestyle factors also play a huge role, with culprits like smoking, drug use, excessive workload, poor sleep, or bad dietary habits at the forefront.

The way that these different culprits wreak havoc on unsuspecting middle-aged men is not as discrete and all mix-and-match together to create the perfect storm. It is important to note that alongside all of this, testosterone levels are also slowly trickling down. Does that mean they contribute too? They may, but that remains a contentious topic.&nbsp;&nbsp; 
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The first step is always to consult a doctor. A testosterone level may reveal that, for the vast majority, though ultimately declining, it will tend to fall within an expected range for the age. Thus, once diseases (like Late-Onset Hypogonadism) have been ruled out, treatment for this common and easily manageable process can begin.&nbsp;

First-line recommendations include revealing the cause and treating accordingly.&nbsp;

As we discussed, stress is a big contributor and thus, therapy (for example Cognitive Behavioural Therapy or CBT) reigns supreme at the forefront of management. Your physician may recommend a trip to a trained therapist for this. 
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If therapy is not possible for any reason, relaxation techniques and healthy routine exercise also help. Online sources have numerous calming methods that can be used, even by untrained people, to subvert the harmful effects of stress. Many apps are specifically designed for meditation purposes and have reported benefits.

Lastly, lifestyle modification may also be helpful if smoking or a bad diet is amongst the offenders. Cutting down on unhealthy addictions and ensuring a balanced food intake is key. 
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Bottom Line

Thus, we see that, to treat a multi factorial disease, we need to cast a wide net, and tackle many different problems simultaneously. An overall healthy lifestyle is the cornerstone of safe and healthy male ageing.