October 23, 2024, 5:50 pm | Read time: 7 minutes

When we talk about the menopause, it is usually associated with women in midlife. But can men actually go through menopause, too? FITBOOK asked urologist Dr. Christoph Pies.

Why men don’t usually experience real menopause

The hormone balance in both men and women changes with age. In women, hormone production in the ovaries decreases from around the age of 40. The production of the female sex hormones progesterone and estrogen is greatly reduced. This can lead to symptoms such as sweating and hot flashes, dizziness, mood swings, sleep disorders, weight gain, or thinning hair^.1

Men also experience hormonal changes. From the age of 30, the production of the male sex hormone testosterone slowly decreases by around one to two percent per year^.2 However, it does not happen as rapidly as in women. This is why the symptoms often go unnoticed or are much milder. In addition, it is not usually associated with infertility. This is why men are not typically described as experiencing menopause. However, this does not rule out the possibility that they may also show signs of menopause under certain circumstances.

When men experience a type of menopause

Although men are not officially described as undergoing menopause, it is evident that they, too, experience physical changes during midlife. Terms such as “andropause,” “PADAM” (partial androgen deficiency in aging men), or “male menopause” are used to describe this phase. These terms essentially describe an age-related testosterone deficiency in men. This can manifest itself with symptoms similar to those experienced by women during menopause:

• Loss of libido
• Lack of drive
• Muscle loss and loss of strength
• Weight gain (especially in the abdomen)
• Mood swings
• Thinning body hair

“In total, over 65 symptoms are described that can typically occur in this phase of life. Questionnaires such as the “Aging Males’ Symptom Scale” (AMS) or the “Hypogonadism Related Symptom Scale” (HRS) systematically map the most important of these symptoms. The categories of physical, psychological and sexual well-being are queried,” explains Dr. Pies, who has published a specialist book on the subject of “Male Menopause” (Männer Ü 50 or “Men over 50”), when asked by FITBOOK.

According to the German Society for Endocrinology (DGE), only three to five percent of men over 60 in Germany are affected by a genuine testosterone deficiency^.3 This is why there is no male menopause, according to the DGE.

These factors influence the onset and severity of symptoms

“The onset and severity depend very much on lifestyle factors! In particular, our diet, social environment, exposure to harmful substances such as tobacco, alcohol, and medication, toxins in the food we eat or the air we breathe, and physical activity have a major influence. The most important risk factors for the development of manifest testosterone deficiency are obesity, chronic illnesses, and poor general health. If the hormone deficiency is caused solely by our lifestyle, it can also be remedied by changing our habits and treating the accompanying illnesses appropriately. Some men with persistent symptoms can benefit from testosterone treatment,” says the expert.

What are the main causes of male menopause?

Organic level

“In a strict hormonal sense, there is no such thing as male menopause! It’s more of a gradual process. Psychotherapist Jed Diamond describes it in his book The Fire Sign Man as follows: ‘Women fall off the cliff into the abyss, while men slowly roll down the hill. In fact, from the age of 45, the concentration of testosterone in the blood decreases by around 0.4 to one percent per year. However, this slight tendency for testosterone levels to decrease with increasing age is offset by the fact that the decrease varies greatly from man to man (as we doctors say, the spread of values increases). In plain language, this means that as a very old man, you can have just as high a testosterone level as a young man. If you do something about it,” says Dr. Pies, explaining the physical changes in aging men.

Psychological level

On a psychological level, men (and women, of course) also face special challenges in midlife. “While youth is defined by the hope of a good job and a happy marriage, people in midlife suspect that this optimism may have been a little exaggerated. Some of their wishes will probably no longer come true. This can be seen in the highest rate of divorce and suicide in this phase of life. Disappointment is therefore concentrated in midlife, statistically around the age of 47. In old age, satisfaction then increases again despite the physical aging process (the so-called “U-curve of happiness” or the “satisfaction paradox”),” says the expert.

What men can do about it

Unlike women, men can do something about their “menopause” caused by a lack of testosterone and even reverse it. They have two options: change their lifestyle and counteract it with hormone therapy.

A healthier lifestyle is often enough to boost testosterone production. Sporting activity is particularly helpful here. Endurance sports, for example, can get rid of unhealthy belly fat. Weight training, on the other hand, counteracts muscle loss and increases hormone production. A healthy diet, less stress in everyday life, and a good night’s sleep not only improve general health but also hormone balance.

If none of this helps, hormone therapy can be administered under medical supervision. The deficiency can be remedied by taking testosterone supplements.

Preventive measures or lifestyle changes to alleviate or delay symptoms

According to the expert, there are several ways to alleviate or even delay the symptoms: “Following just four of the following recommendations will increase your chances of keeping your testosterone levels intact. If you even manage to follow all the recommendations, you have almost guaranteed protection against testosterone deficiency, and as a bonus, you will achieve an enormous increase in quality of life; even life expectancy can increase by up to 14 years. However, what sounds so simple and obvious is unfortunately implemented far too rarely in reality.” According to him, only around one in ten men meet all of the following criteria:

• do not smoke
• more than three hours of sport per week
• less than six alcoholic drinks per week
• eat fish more than three times and meat less than six times a week
• less than 5 g of salt per day
• little and only low-fat milk
• sleep at least eight hours

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A “midlife crisis” may be the underlying issue

If men have the feeling that they are going through a kind of “menopause,” psychological factors can also play a major role, as already mentioned. This then leads to the famous “midlife crisis.” This term describes a crisis of meaning that many men feel in the middle of their lives, usually between the ages of 40 and 55. It is a complex interplay of various factors that leads to a midlife crisis. The loss of vitality and attractiveness, confrontation with younger generations, a negative life balance, missed goals or no goals for the future, dissatisfaction in a partnership, hormonal changes, and health complaints – all of these can trigger a crisis of meaning.

As the statutory health insurance provider AOK reports, a midlife crisis can manifest itself in the following symptoms^:4

• Increased competitive thinking
• A negative self-image
• A sudden preoccupation with illness and death
• A focus on health and appearance
• Increased irritability
• Unusual spontaneity
• The tendency to isolate oneself
• Extreme behavior such as alcohol or drug abuse, affairs, gambling, and high willingness to take risks

For those affected, it is crucial to feel valued, understood, and positively reinforced. This enables them to develop a better sense of self-worth and get through the crisis. However, outsiders are sometimes unable to do this. So, if you are experiencing a crisis of meaning and no longer enjoy life, you should seek therapeutic support.