Andropause is significantly less recognised and spoken of than menopause which is a clearly defined and measurable process affecting 100% of women who reach middle age and, although not a disease, awareness of menopause amongst patients is significant and it receives a lot of attention in the medical world too. In menopause, oestrogen levels decline sharply and predictably around age 50, leading to a wide variety of clearly defined symptoms known formally as ‘menopause syndrome’. It’s extensively researched, and women have a wide variety of management options available to them.
The scenario in men, however, is quite different. There is firstly far less awareness of the potential hormonal and psychological changes that middle aged men experience. This is probably because the process is far less defined, more difficult to measure, its onset is far more gradual, and the array of symptoms as well as their intensity therefore is highly variable. The term ‘andropause’ is used to describe ‘male menopause’ but researchers and the medical world remain divided on this phenomenon. In this article we unpack ‘andropause’ and try to shed some light on this ambiguous yet very real condition.
Factors contributing to ‘andropause’
Unlike oestrogen in menopausal women, testosterone levels in healthy men don’t suddenly drop at a defined point. Usually male testosterone levels decline gradually by 1-2% annually from the age of 30-40 years onward. Unlike the ovaries, the testes, which is where testosterone is produced, can remain relatively active even into old age with men still being able to produce sperm well into their 80’s. Clearly ‘andropause’ physiologically is quite different to menopause then, and there are most likely other factors involved rather than simply being an overt hormone deficiency.
In addition to declining testosterone levels, older men seem to convert larger portions of their valuable testosterone into oestrogen (a process called aromatisation) and into a form of testosterone call DHT. Higher levels of oestrogen are problematic in men and responsible for changes in body shape and fat distribution, and possibly contributing to metabolic syndrome. DHT unfortunately makes the prostate grow (BPH – benign prostatic hypertrophy) and causes male pattern baldness.
In some men, specifically type 2 diabetics or obese men, testosterone levels can drop more sharply, which is referred to medically as ‘late onset hypogonadism’. This basically means that for some reason the testes stop producing testosterone, which produces far more overt and intense symptoms but is not part of the normal ageing process.
2. Psychological and lifestyle factors
Some researchers suggest that ‘andropause’ in addition to gradual hormonal decline could really be more attributable to psychological and lifestyle factors. The dreaded ‘midlife-crisis’ is an ambiguous term to describe a psychological realisation of reaching the halfway mark of life. This is often a contemplative point where one often reflects on what has been achieved and unfortunately what has not and may be associated with depression. Middle age is often loaded with additional stress factors such as marital problems, financial pressures, or other health concerns which themselves can lead to burnout, anxiety and depressive like symptoms. Middle aged men are also likely to be exercising less, gaining weight, consuming more alcohol, possibly smoking, and very likely eating an unhealthy diet. All these possibilities may further add to the gradual decline in testosterone and explain the andropause experience.
Possible signs and symptoms of andropause
Specific low testosterone signs include:
- Low energy and poor recovery from exercise
- Depressed mood – possibly emotional, sensitive or weepy
- Loss of muscle tone and muscle mass
- Abdominal weight gain
- Development of breast tissue in men
- Negative effect on memory and cognition
- Nerve pain or numbness
- Lowered bone density (often undetected)
- Low libido, erectile dysfunction, low sperm count (infertility)
- Sleep disturbances including night sweats
All men should be having annual medical check-ups, and those over 50 years of age should also be having their prostate checked regularly. In cases where low testosterone is suspected, a simple blood test can confirm or rule this out. ‘Andropause’ requires a holistic approach and is typically not simply about replacing testosterone. Although testosterone supplementation is available for severe cases, consider seeing an integrative doctor or complementary medical practitioner to explore alternatives first, as taking supplemental testosterone-like and hormone replacement therapy carries risks. Seeing a psychologist is also a good idea for anyone reaching midlife especially if this is accompanied by emotional symptoms. Below we list a variety of supportive interventions one could consider as a holistic approach to andropause.
Dietary, lifestyle and natural supportive remedies:
- Limit alcohol consumption – Alcohol can lower testosterone levels and increase oestrogen levels in men, and worsen or increase the risk of metabolic syndrome.
- Control stress – excess cortisol caused by stress may inhibit testosterone production and increase weight gain – consider Bio-Strath, A.Vogel Neuroforce and/or A.Vogel Nervousness & Insomnia Formula as natural interventions for stress.
- Stay physically active – Resistance exercise promotes testosterone production and will slow down weight gain.
- Ensure adequate sleep – Testosterone is released and produced significantly during REM sleep. If sleep is broken, production may be compromised. Consider A.Vogel Dormeasan to promote a better night’s sleep.
- Avoid xenoestrogens – These are external substances which have an oestrogen like effect in the body. Additional oestrogen like effects will worsen andropause symptoms. Filter drinking water, avoid use of plastics, and limit non-organic red meat and dairy products.
- Consume aromatase inhibiting foods – this will inhibit the conversion of testosterone into oestrogen. These include:
- Cruciferous vegetables – broccoli, Brussel sprouts, cauliflower.
- Foods rich in omega 3 fatty acids such as fish, avocado, nuts, seeds, coconut oil. A.Vogel VegOmega-3 is a good source of Omega 3.
- Consume foods from the allium family of plants which include onions, garlic, chives, and leeks all of which promote the breakdown of oestrogen and detoxification in the liver.
- Include herbs which contain flavones such as chamomile and passionflower often available as herbal teas also have aromatase inhibiting effects.
- Fermented foods such as sauerkraut, kombucha and kimchi assist to detoxify excessive oestrogen and inhibit aromatase – consider A.Vogel Molkosan, a fermented food supplement made from whey.
- Support healthy liver function – the liver is the site where excess oestrogen is metabolised and broken down as part of the eliminatory system. Sluggish liver function could inhibit this process and worsen andropause symptoms. Consider A.Vogel Boldocynara as a general liver tonic to support liver function.
- A.Vogel Prostasan – Saw palmetto has been shown to inhibit the conversion of testosterone to DHT and simultaneously addresses BPH which may also occur in andropause.
References and additional reading:
- Singh, P., Andropause: Current concepts. Indian J Endocrinol Metab, 2013. 17(Suppl 3): p. S621-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/
- South African Depression and Anxiety Group https://www.sadag.org/
- Healthy Male https://www.healthymale.org.au/
- Mens Health Resource Centre https://www.menshealthresourcecenter.com/