Manopause and the Male Biological Clock

Have you driven the same old car for years, but now suddenly have the urge to get the newest Corvette? Do you find yourself obsessing about other people who are half the age of your spouse? Are you feeling really old and depressed around the younger bucks at work? Are your sex drive and erections plummeting faster than a lead balloon? Maybe you’re experiencing “manopause.”

 What is Manopause?

Manopause, a term used to describe the “male change of life,” was coined in 1991 by Dr. Stanley Korenman at UCLA. Not happy with the term “male menopause,” he defined manopause as “an umbrella term to describe age-related alterations whose exact nature is still to be determined.” True enough, two and a half decades later, its nature remains yet to be determined.

For sure, manopause is similar to the female menopause, a term that describes that brief period in a woman’s life during which the ovaries cease to work. That means the end of ovulation and periods, some hot flashes and much lower female hormone levels. Manopause differs in that it involves a slow, steady decline in testosterone levels. Because this change occurs over several decades, it often goes undiagnosed. Popular culture tends to associate these hormonal changes with “midlife crises.”

It has recently become clear that about 50% of men experience significant symptoms of manopause at some time in their lives.

What are Manopause Symptoms?

Since they walk hand in hand, the real question is does aging itself lead to hormonal changes or do the hormonal changes age us? It’s a chicken-egg thing. Regardless, this is what happens to men during manopause:

  • Decreased sexual function, including libido, erections and fertility
  • Loss of height, muscle, strength, endurance and performance
  • Frailty and decreased bone density
  • Fatigue and diminished energy
  • Memory loss and poor concentration
  • Increased body fat
  • Irritability, anger, anxiety, aggression, sadness and depression
  • Anemia (low blood counts)
  • Loss of body hair, tender breasts, shrinking testes
  • Sleep apnea
  • Heart disease

The problem is that it’s often difficult to tell which of these symptoms is due to normal aging, diseases such as diabetes or obesity, or lower testosterone levels. Some men also assume they are experiencing manopause when what they really have is depression. This makes getting a proper diagnosis critical as testosterone does not help with symptoms due to many well defined and treatable disorders.

As you might surmise, given the complexity of these things, testosterone treatment for manopause may not be the Holy Grail you’d think it’d be. Maybe it’s testosterone-related and maybe it isn’t.

My theory is that, yes, testosterone decreases slowly in all men and this is part of normal aging. However, other medical conditions such as heart disease, obesity and diabetes speed things up and lower testosterone levels at a rate that is much faster than normal for aging. As a consequence, manopause symptoms occur earlier or are more severe than expected. This warrants some care.

 How to Treat Manopause?

So what’s a clinician to do? In my practice, I perform a thorough history and physical exam and search for potential medical causes of these symptoms, then treat or refer appropriately. I encourage healthy eating, weight loss and regular exercise. I prescribe getting plenty of rest, reducing stress of all kinds, keeping your mind active, and limiting alcohol use. And, yes, knowing what happens to testosterone as men age, I will top off testosterone levels to match those of younger men.

I monitor the progress and health of these patients closely, as I would for any hormone replacement therapy patient. While testosterone therapy is safe under supervision, risks include acne, sleep disorders, enlargement of breast and prostate and blood clots. Notably, men with normal hormone levels who seek a boost in testosterone tend not to experience real health benefits, so I do not endorse this treatment for older men who are simply hoping for an improved sex life.

So, although men can get “complicated” around mid-life, they really aren’t. In the words of Isaac Newton: “Truth is…found in simplicity, and not in the multiplicity and confusion of things.”