The male menopause—does it exist?

British Medical Journal,  March 25, 2000  by Duncan C Gould,  Richard Petty,  Howard S Jacobs

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Male ageing is associated with an increase in central and upper body fat deposition and reduced muscle mass and strength. This could be explained by an age associated decline in growth hormone concentrations, which itself is associated with an increase in sex hormone binding globulin and therefore a reduction in bioavailable testosterone.[27] There is consensus that testosterone supplementation in hypotestosteronaemic men improves fat free mass, muscle bulk, and strength.[28 29] Profound hypotestosteronaemia in younger men results in accelerated bone loss and osteoporosis.[30] In older men bioavailable testosterone concentrations are positively correlated with bone mineral density at the radius, spine, and hip,[31] and men with hypotestosteronaemia have been reported to be at increased risk of hip fracture.[32] Data on the effects of testosterone replacement therapy on bone metabolism in hypotestosteronaemic men are limited but suggest beneficial effects.[33]

Vasomotor disturbance and night sweats occasionally occur, their association with testosterone deficiency and relief by testosterone replacement being noted as far back as the 1930s.[4 5 34] Androgens also have an important role in the development of cognitive functioning, and in men strong correlations exist between testosterone concentrations and visuospatial abilities in certain domains.[35] Testosterone administration to ageing men has been shown to enhance certain visuospatial skills.[36]

Hypogonadism (like hypothyroidism) is a pathological state and is associated with several other comorbid factors such as the presence of cardiovascular risk factors (obesity, higher waist:hip ratio; higher concentrations of glucose, insulin, total cholesterol, low density lipoprotein cholesterol triglycerides, apolipoprotein B, fibrinogen, and plasminogen activator inhibitor I; and lower concentrations of high density lipoprotein cholesterol C and apolipoprotein A I), which are improved by testosterone administration.[37]

Investigations and treatment

Whatever the nomenclature, be it male menopause or climacteric or age related hypotestosteronaemia, men presenting with symptoms outlined in rite box should be investigated. Investigations should include assessments of concentrations of plasma gonadotrophin, prolactin, and sex hormone binding globulin and early morning concentrations of testosterone. Men with hypotestosteronaemia with unequivocal signs and symptoms of androgen deficiency, and when reversible causes of testosterone deficiency and contraindications have been excluded, should be offered treatment with testosterone replacement therapy in line with the current WHO guidelines[38]--this is, however, a specialty beyond the scope of this article.

Symptoms encountered in the male climactericsyndrome[5]

Depression, nervousness

Flushes and sweats

Decreased libido

Erectile dysfunction

Easily fatigued

Poor concentration and memory

We thank Dr Pierre Bouloux, reader in endocrinology, centre for neuroendocrinology, Royal Free Hospital School of Medicine, London, for reviewing this manuscript and assisting in its preparation.