Is male menopause real?

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Q. Do men go through a phase similar to what women experience with menopause?

A. You look in the mirror one day, perhaps in your 50s or early 60s, and you ask yourself, "Where did those love handles come from? Why do my once muscular pecs now sort of sag? And what about my diminished interest in sex? When did that happen?"

Perhaps it even gets you thinking: am I entering "male menopause"? Like women, men experience a drop in sex hormone levels as they age. But in men, the pace of these changes is quite different. In women, levels of estrogen, the primary female sex hormone, remain high for many decades. Then, around age 50, the levels plunge over a period of about five years. The lower levels of estrogen cause the physical and psychological changes of menopause, including the cessation of menstrual periods. When a woman enters menopause, it's easy for her to tell.

For the vast majority of men, the change is much more gradual. Levels of a man's main sex hormone, testosterone, begin to drop as early as age 30. Instead of plunging within a few years, testosterone levels drop slowly (about 1%) each year for the rest of his life. This change is so gradual that many men don't notice the effects for several decades.

So, the question remains: Do the progressively lower levels of testosterone cause symptoms in a man, the way lower levels of estrogen do in a woman? There is no doubt that they can, but it can be hard to tell.

There are situations when a man might experience an abrupt fall in testosterone because of an injury or illness, chemotherapy or radiation treatment, or certain medications. Extremely low levels can clearly cause loss of muscle mass and bone strength, increased body fat, drop in energy, less interest in sex, and erectile dysfunction. In these cases, the term "male menopause" could be applied, and testosterone replacement therapy (TRT) may improve the symptoms.

However, in the average man, linking testosterone levels to symptoms is tricky, and it's hard to predict which men with low levels can benefit from TRT. Testosterone levels vary among men of the same age, and men experience testosterone deficiency symptoms at different levels. In fact, many men with low levels have no symptoms.

If you've experienced changes that could be related to low testosterone, speak with your doctor. He or she will first want to explore whether your symptoms are related to another cause, such as overuse of alcohol, a thyroid problem, or depression. The next step is to measure your blood level for total testosterone. Because levels fluctuate throughout the day, the test should be done in the morning and repeated at least once to ensure accuracy. Most laboratories use 300 to 1,000 nanograms per deciliter as the normal range for total testosterone. Based on your results and your symptoms, you and your doctor might discuss TRT. But keep in mind that your testosterone level and how you feel may not be connected.

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