Overview

The male equivalent of menopause is called andropause. While the symptoms of andropause are often less overt than those of menopause, men may experience problems such as

  • Loss of muscle mass
  • Fatigue
  • Decreased assertiveness
  • Decreased libido
  • Erectile dysfunction
  • Low sperm count
  • Testicular atrophy
  • Depression

Please see conventional, complimentary and alternative medical treatments for important background information regarding the different types of medical treatments discussed on this page. Naturopathic, Complimentary and Alternative treatments that may be considered include:


Etiology

Andropause occurs when the gonads (testes) fail to produce sufficient testosterone. This may be either primary failure (testes do not respond to FSH and LH hormones produced by the pituitary), or secondary failure (the pituitary fails to produce sufficient FSH and LH to stimulate the testes). A simple blood test (FSH, LH, free Testosterone, and total Testosterone) can distinguish between these two scenarios.


Differential Diagnosis


Treatment

While it is clear that low testosterone levels are harmful to men's health, there is controversy regarding how high treatment should raise testosterone levels to. The most conservative approach only seeks to raise testosterone levels to the age-matched "normal" range. The most aggressive approach seeks to restore testosterone levels to that of a healthy young man. There remains controversy about whether low testosterone or high testosterone causes greater health concerns. But it is obvious that young men who have relatively high testosterone levels suffer less cancer and other health problems than older men with relatively low testosterone levels. See breast and prostate cancer for Dr. Weyrich's current view on testosterone safety as it applies to cancer.

Optimize Thyroid Function

In many cases correcting hypothyroidism will cause the body to produce more of its own testosterone or otherwise relieve the symptoms attributed to low testosterone. This should always be done before progressing to the treatments below.

Low Dose Clomiphene (Clomid)

In the case of secondary failure, the low doses of the fertility drug clomiphene (Clomid) may be used to stimulate the testes to produce more testosterone. This has the advantages of maintaining male fertility (sperm count), not causing testicular atrophy, and producing less estrogen than what occurs in testosterone replacement therapy.

In one study, 36 Caucasian men, with untreated (blood serum) testosterone levels averaging 247.6ng/dL and a testosterone/estrogen ratio of 8.7, were treated with 25mg clomiphene per day for 4-6 weeks. Average testosterone level rose to 610.0ng/dL, and the testosterone/estrogen ratio improved to 14.2 [Shabsigh2005  🕮 ].

Testosterone Replacement Therapy (TRT)

In the case of primary failure, replacing the testosterone that the testes can no longer make with exogenous in applications of bio-identical testosterone is appropriate. The mode of application can be a daily topical cream or gel, weekly injections, or monthly pellets. Synthetic oral forms have been tried in the past, but were withdrawn from the market due to unacceptable risks. These methods have the downside that they cause testicular atrophy, infertility and low sperm count, and increase estrogen levels.

Testosterone is regulated by the FDA as a drug subject to abuse, and in order to legally prescribe testosterone replacement therapy, a doctor must document abnormally low levels of testosterone.

Some practitioners have expressed concern that supplementing with testosterone may increase the risk of prostate cancer. However, other researchers have reported that testosterone has a protective effect [Starr2005, pg 196], [Carruthers2001]. Indeed, the incidence of prostate cancer appears to increase with age, as endogenous testosterone levels decline.

As discussed in breast and prostate cancer, elevated estrogen levels are more problematic than high normal testosterone levels. Since TRT tends to raise estrogen levels to unhealthy levels, estrogen levels must be monitored during TRT, and if necessary, natural or pharmaceutical approaches to lowering the conversion of testosterone to estrogen (i.e. aromatase inhibitors) may be required.


References