Raymond Hobbs (copy) (copy)


Although most men are aware of menopause — loss of menstrual periods associated with low estrogen levels in women — many are unaware that andropause, something similar, occurs in men. Unlike menopause, the changes of andropause are subtle with a gradual decline in testosterone levels starting around age 30.

After 40, testosterone production falls by about 1 percent annually. Forty percent of men at 45 or older have low testosterone levels. This can decrease sex drive, interfere with erections, cause loss of muscle mass and strength and lead to depression and difficulty with sleep. It can also cause slight enlargement of the male breasts.

Although testosterone is produced in the testicles of the male, its production is complex and under the control of the brain (hypothalamus) and the pituitary gland under the brain. The pituitary releases two hormones (LH, FSH) that stimulate the testicles to produce testosterone and sperm. This production is not constant, but varies throughout the day and is affected by sleep. It can also be affected by age, illness, accidents, some medications, nutrition and alcohol.

Testosterone levels can be measured with a simple blood test but aren’t routinely checked because many people don’t know about them and the changes can be gradual and subtle.

Symptoms of changing hormones

Men who feel like they may be experiencing hormonal changes should speak with their health care provider and inquire about a testosterone level test.

Some symptoms of low testosterone may include decrease in spontaneous erections, decreased energy or motivation, discomfort or swelling of the breasts, infertility, loss of muscle mass, reduced sex drive, sweating, weight gain, inability to concentrate on tasks, feelings of depression and erectile dysfunction.

Diagnosis and treatment of low testosterone

Because the production of testosterone is complex, other blood tests may be needed to precisely identify why levels may be low. Frequently, the health care provider will refer the patient to an endocrinologist, a specialist in glandular disorders for further evaluation.

For men with symptoms of changing hormones who have age-related low testosterone levels, doctors may prescribe hormone therapy. This can be done with injections, gels and less frequently, pills. They may set a testosterone-level target and explain how follow-up testing will occur to measure the treatment’s effectiveness.

Some men aren’t good candidates for hormone replacement therapy, even if their testosterone levels are low. Men who should avoid this may include those who recently had a heart attack, recently had a stroke, experience severe sleep apnea or diagnosed with breast or prostate cancer.

Low testosterone levels stemming from andropause is a common problem in men that goes unnoticed by many who are unaware and don’t realize how treatable it is. If you or a loved one is concerned about andropause, please see your health care provider.

Try adding healthy habits

Men struggling with symptoms of low testosterone may find some relief by focusing on improving their health. This can be done by concentrating on bringing their lifestyle back to basics with nutritious foods, regular exercise and adequate sleep. These lifestyle changes may help lessen some of the symptoms men experience as they age.

About the author: Raymond D. Hobbs is senior medical director at Blue Cross Blue Shield of Michigan.

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