While there’s currently a lot of focus on female menopause, men also go through their own version of menopause called andropause. Andropause is the gradual decline in testosterone levels as men grow older, usually beginning in the 4th decade of life. Andropause has its own characteristic symptoms, both emotional and physical, including mood changes like anxiety, depression, brain fog, low motivation, and irritability/anger; decreased muscle mass; low energy levels; erectile dysfunction; sleep disturbances; and decreased libido. These symptoms are similar to what many menopausal women experience, but usually less severe.
Marketing campaigns in the early 2000’s popularized the term “low T” and boosted interest in TRT (testosterone replacement therapy). Approximately 24 to 39% of middle-aged men (30 to 79 yrs of age) fall under the category of low testosterone levels, defined as less than 300ng/dL, and testosterone levels are decreasing at a faster rate than previously observed, most likely due to an increase in poor health among middle-aged men and/or environmental factors. But does this mean that most middle-aged men should be requesting testosterone supplementation? The short answer is no and here’s why:
While a significant portion of middle aged men experience low testosterone levels, only about 6% of them will experience clinical signs of “androgen deficiency” – the negative symptoms that accompany low testosterone levels, and replacement in the absence of symptoms is not recommended. It’s also important to note the downside of testosterone supplementation, which includes an increased risk of cardiovascular events like heart attack, stroke, and blood clotting, especially in older men and those with pre-existing heart disease; infertility; worsened sleep apnea; enlarged prostate glands and elevated PSA (prostate-specific antigen) levels; testicular shrinkage; and acne.
If you’re a middle-aged man and you’re concerned about low testosterone, we encourage you to have a conversation with your primary care doctor or urologist, but there are also some effective lifestyle interventions for managing symptoms. These include:
- Resistance training like weightlifting and body weight resistance exercises
- Limiting alcohol intake
- Managing stress
- Getting adequate sleep (aim for at least 7 hours/night)
- Maintaining a healthy weight
While these are relatively simple strategies, that doesn’t mean they’re easy to incorporate, but adopting as many of them as possible will not only help combat declining testosterone levels as you age, but will also be great for your gut and overall health.
