Male menopause, also called "andropause" or late-onset hypogonadism, supposedly results from declines in testosterone production that occur later in life, but there has been some debate on how real the male menopause phenomenon is.
According to the study only about 2% of men aged 40 to 80 suffer from male menopause, far less than previously thought.
"Some aging men indeed suffer from [male menopause]. Male menopause is a genuine syndrome, but much less common than previously assumed," concluded Dr. Ilpo Huhtaniemi, senior author of a study published online June 16 in the New England Journal of Medicine.
"This is important because it demonstrates that genuine symptomatic androgen deficiencies [androgens are male hormones] is less common than believed, and that only the right patients [should] get androgen treatment," added Huhtaniemi, a professor of reproductive endocrinology in the department of surgery and cancer at Imperial College London.
Male Menapause Study
For this study on testosterone levels in men, the research team, from Imperial College London and the University of Manchester, measured testosterone levels in 3,369 men aged 40 to 79 and then correlated these levels with different symptoms.
Of 32 possible symptoms, only nine were linked with decreased testosterone levels.
- Three sexual symptoms -- less frequent morning erections, lower sex drive and erectile dysfunction -- were more robustly related to testosterone levels.
- Three were psychological -- low energy, sadness and fatigue, and three were physical -- not being able to engage in strenuous physical activity, not being able to walk more than 1 kilometer and not being able to bend over or kneel. These six symptoms were only peripherally linked to low testosterone levels.
Men need to have all three sexual symptoms plus measurably lower levels of testosterone to qualify for the diagnosis of late-onset hypogonadism, the authors stated.
Testosterone Therapy for Anti Aging?
Many men have been taking testosterone supplements to combat the perceived effects of aging, even though it's not clear if taking these supplements help or if they're even safe. The result has been mass confusion, not only as to whether male menopause exists but also how to treat it.
"A lot of people abuse testosterone who shouldn't and a lot of men who should get it aren't," said Dr. Michael Hermans, an associate professor of surgery in the Texas A&M Health Science Center College of Medicine and chief of the section of andrology, male sexual dysfunction and male infertility at Scott & White in Temple, Texas.
"Just because an older guy comes in and says he has a bad sex life, you don't automatically give him testosterone," added Hermans.
And even though there are any number of testosterone products available -- from patches to pellets -- there isn't much research on how much they really help men, Hermans said, or whether they are safe.
New Diagnostic Criteria No Solution for Anti Aging
But even with this new diagnostic criteria for male menapuae, the challenge of treating men with sexual and other symptoms of male menopause is still far from straightforward.
"These symptoms that are associated with hypogonadism (male menapause) are not necessarily going to be treated by testosterone therapy," pointed out Dr. Natan Bar-Chama, director of male reproductive medicine and an associate professor of urology at Mount Sinai Medical Center in New York City. "We know very well that erectile dysfunction is complicated. It's associated with other co-morbidities and the ability to regain normal erectile function is often not successfully treated with just testosterone."
SOURCES: Ilpo Huhtaniemi, M.D., Ph.D., professor, reproductive endocrinology, department of surgery and cancer, Imperial College London; Natan Bar-Chama, M.D., director, male reproductive medicine, and associate professor, urology, Mount Sinai Medical Center, New York City; Michael Hermans, M.D., associate professor, surgery, Texas A&M Health Science Center College of Medicine, and chief, section of andrology, male sexual dysfunction and male infertility, Scott & White, Temple, Texas; June 16, 2010, New England Journal of Medicine, online