bodyType

customContents

entityId

entityUuid

articlePageQuery

filter

article

articleBaseAdvertisingInfoArticle

articleListArticle

articleSeoArticle

helpersCheckIsPostiesArticle

hooksArticleAcknowledgementGateOverlayArticle

hooksTrackPageViewArticle

hooksContentInterestArticle

articleLinkingDataContent

articleSchemaContent

liveArticle

advertZone

sentiment

contentLock

topics

types

sections

moreOnThisArticles

urlAlias

commentCount

sponsorType

authorLocations

authors

paywallTypes

corrections

displaySlideShow

multimediaEmbed

printHeadline

seriesContainer

socialHeadline

headline

flag

firstTopic

glossary

flattenTypeIds

publishedDate

additionalInfoBoxes

images

image

relatedLinks

relatedNewsletters

__typename

createdDate

sponsor

factSheets

series

knowledgeQuestion

disableOffPlatformContent

published

updatedDate

summary

subHeadline

body

keywords

copyrighted

customTimezone

liveContents

Tribune News Service

Thanks to menopause, almost everyone knows something about how age affects hormone levels – in women.
But while menopause has launched 1,000 jokes about hot flushes, men have their own version. It is called andropause, and although it is less of a pop-culture presence, it is a medical reality that is subject to misconceptions, experts say.
They start with equating it to menopause.
In women, menopause is when menstruation stops. The ovaries stop producing eggs, and the production of oestrogen declines. It typically happens around the age of 50 but can begin earlier.

In men, andropause is a decline in testosterone levels that can begin in middle age, then it is “a gradual fall”, said Dr Robert Eckel, a professor of medicine emeritus at the University of Colorado Anschutz Medical Campus in the US state of Colorado.
“It is nothing like menopause, which occurs over a finite period of time.”
According to the American College of Physicians, a man’s testosterone level begins to drop in his mid-thirties and continues to fall at an average rate of 1.6 per cent a year.
A study published in the medical journal Virulence in 2016 calculated that by age 75, a typical man will have lost about 30 per cent of the testosterone he had at 25.
Testosterone plays roles in sexual function, bone health, fat metabolism, muscle mass and strength. Levels surge in adolescence with puberty. But advice varies on when low levels should be a cause for concern.
Low testosterone is sometimes referred to as hypogonadism, and andropause can also be referred to as age-related hypogonadism.

Dr Nannan Thirumavalavan, chief of male reproductive and sexual health at the Urology Institute of University Hospitals in Cleveland, in the US state of Ohio, said there’s no “perfect answer” for how to distinguish between normal age-related decline and a more serious problem.
When testosterone levels fall, the most specific symptoms are a decreased sex drive or erectile dysfunction, said Thirumavalavan, who also is an assistant professor of urology at Case Western Reserve University School of Medicine.
Other symptoms can include difficulty concentrating, decreased energy or even depression.
Of course, “there are many, many things that could cause those symptoms”, he said.
In younger men, low testosterone can indicate problems with the pituitary gland or the testicles, Thirumavalavan said. But testosterone levels also can be affected by some of the same factors linked to cardiovascular disease, such as obesity, sleep quality and sleep apnoea.
People with type 2 diabetes, another cardiovascular risk factor, or kidney disease also tend to have lower testosterone levels, Eckel said, adding that “it needs to be made clear that, although related, the causation is not clear”.

Observational studies have shown that men with unusually low testosterone levels appear to have a higher risk of cardiovascular disease, but that is not the same as showing a cause and effect, Eckel said.
“Is the risk for cardiovascular disease that occurs in those settings entirely due to lower levels of testosterone? Certainly not.”
A declining testosterone level, Eckel said, isn’t necessarily a concern unless it goes beyond a modest decline in sexual function. But if lower testosterone is accompanied by a loss of muscle, excess fatigue, anaemia or profound sexual dysfunction, then the patient should be evaluated by an endocrinologist, he said.
“Male hypogonadism in the older man is a challenging diagnosis to make,” Eckel said, requiring “both biochemical measurements and a good history and physical examination”.
The diagnosis requires multiple blood tests. A normal testosterone reading can vary from man to man, and levels fluctuate throughout the day. “We never want to just treat a number,” Thirumavalavan said.
But while treatments for low testosterone – sometimes called “low T” – have been heavily marketed in recent years, Eckel said guidelines from the Endocrine Society do not support routine testing of testosterone levels.

Those guidelines say low testosterone readings alone, without symptoms, do not establish hypogonadism, and the benefits and adverse consequences of long-term testosterone therapy “on patient-important outcomes in asymptomatic men with low T concentrations remain unclear”.
For men older than 65, the guidelines suggest offering therapy “on an individualised basis after explicit discussion of the potential risks and benefits”.
Many men seek testosterone therapy because of libido issues.
“There’s no question that sexual function declines with age, and that’s probably normal ageing,” Eckel said. Testosterone therapy provides “a modest improvement in sexual function”, he said. It will not turn a 75-year-old man into a 25-year-old, “but it is a little bit better”.
A man seeking help for symptoms of low testosterone could start by talking to his primary care doctor, urologist or endocrinologist to get some tests done, Thirumavalavan said.
Testosterone therapy is not a casual treatment, though, he said. It “basically will shut down your own testicles”, he said, ceasing sperm production – a problem for someone hoping to father children. (Testosterone is being studied as a hormonal form of birth control for men.)

Other potential side effects, Thirumavalavan said, include acne and increased blood pressure.
The US Food and Drug Administration requires manufacturers of testosterone products to warn users about a possible increased risk of heart attacks and strokes.
Eckel noted, however, that a major study published last year in the New England Journal of Medicine showed that testosterone replacement therapy did not increase risks of major cardiac problems in middle-aged and older men.
It was an important step in showing that testosterone replacement can be done safely, Eckel said.
American Urological Association guidelines say that someone who has had a cardiovascular event should not begin testosterone therapy until three to six months afterwards.
Over-the-counter supplements are not an alternative, Thirumavalavan said. Although the market is booming, there is no evidence that the most common ingredients in them work, according to a review he co-wrote that was published in 2019 in The Journal of Sexual Medicine.
Generally, he said, men can improve their testosterone levels by getting quality sleep, losing excess weight, eating a healthy diet and exercising.
Like what you read? Follow SCMP Lifestyle on Facebook, Twitter and Instagram. You can also sign up for our eNewsletter here.


‘Miracle’ GLP-1 agonist weight-loss drugs help US woman shed 18kg, stop her prediabetes

How strength training reverses bone-density loss,  beats osteoporosis, as Hongkonger found

Hamas leader’s death brings a chance for peace. We must seize it

After baby massage saved her from postnatal depression, mother holds Hong Kong classes

Wellness

Myths about the ‘male menopause’, andropause, and steps men can take to slow it down

If lower testosterone levels are accompanied by a loss of muscle mass or strength, a man should probably see a specialist to discuss potential treatment.
Photo: Shutterstock

Many men seek testosterone therapy because of libido issues, as sexual function typically declines with age. The “male menopause” begins in the mid-thirties. Photo: Shutterstock 

Dr Robert Eckel is a professor of medicine emeritus in the Division of Cardiology at the University of Colorado. Photo: Dr Robert Eckel

The most specific symptoms of falling testosterone levels are erectile dysfunction and a decreased sex drive, says Dr Nannan Thirumavalavan, chief of male reproductive and sexual health at the Urology Institute of University Hospitals in Cleveland. Photo: University Hospitals 

A man seeking help for symptoms of low testosterone could start by talking to his primary care doctor. Photo: Shutterstock

Men can improve their testosterone levels by losing excess weight and eating a healthy diet. Photo: Shutterstock

If lower testosterone levels are accompanied by a loss of muscle mass or strength, a man should probably see a specialist to discuss potential treatment. Photo: Shutterstock

How do you age well? Ask this super fit Korean couple, 62 and 57, going viral on Instagram

Korean fitness couple Kang Changdong and Kim Sunok (right) are fit, toned, healthy – and in their 60s and 50s. Photo: Instagram/@okdong_fit

Fans love seeing happy moments the couple have with their son and daughter. Photo: courtesy of Kim Sunok

Three years ago, Kim (right) started to work at the company Kang (left) founded in 2008. Photo: courtesy of Kim Sunok

Keeping a strict diet was a non-negotiable for Kang when he was preparing for a “body profile” photo shoot. Photo: courtesy of Kim Sunok

Kim said lifting weights at the gym was the best way to get into the best shape of her life. Photo: courtesy of Kim Sunok

In an Instagram post of a tropical holiday, the couple tuck into rainbow-hued salads. Photo: Instagram/@okdong_fit

What is sudden cardiac arrest? Causes, prevention and how to help someone struck by one

Denmark’s Christian Eriksen lies on the pitch after suffering a sudden cardiac arrest during the Euro 2020 soccer match between Denmark and Finland on June 12, 2021. Photo: AP

Denmark’s Joakim Maehle reacts as his teammate Christian Eriksen lies on the pitch after suffering a sudden cardiac arrest during the Euro 2020 soccer match between Denmark and Finland on June 12, 2021. We look at the causes of sudden cardiac arrest, how to prevent it in young athletes, and how to save the life of someone suffering one. Photo: AP

Chinese badminton players and coaches (in white jackets and black armbands), along with all players competing in the 2024 Badminton Asia Junior Championships, pray together for the late Chinese player Zhang Zhijie, in Yogyakarta, Indonesia, on July 1, 2024. Photo: AFP

Dr Myles Chan is a specialist in cardiology and an honorary assistant professor in the department of medicine and therapeutics at the Chinese University of Hong Kong. Photo: CUHK  

Italian law mandates that every competitive athlete must undergo an annual pre-participation evaluation to identify cardiovascular diseases that pose a risk of sudden death during sport. Photo: Shutterstock

Dr Boon Lim is a London-based consultant cardiologist and electrophysiologist. Photo: Dr Boon Lim

An AED should be available in any competitive sporting arena, Chan says. Photo: Shutterstock 

‘Astonishing’ news on obesity and exercise: 30 minutes a week can offset heart health risk

Obese people with belly fat who do 30 minutes of vigorous exercise a week such as running have the same risk of cardiovascular disease as non-obese people, a study found. Photo: Shutterstock

Obese people who cannot manage vigorous exercise can do moderate exercise instead, such as a light jog or walk, to offset the risk of developing cardiovascular disease, but will need to do 8-9 hours a week, a study suggests. Photo: Shutterstock

Some activities, such as balance training and stretching, are light in nature, but should still be encouraged, says Professor Melody Ding, who suggests everyone should be as active as they can be. Photo: Shutterstock 

Researcher Melody Ding is a professor of public health at The University of Sydney. Photo: Melody Ding

Heart attack survivor learns to take charge of his health, and teaches others to do so too

Heart attack survivor Mathew Gomes cycles three to four days a week in Hong Kong. Photo: Jonathan Wong

After a heart attack, Mathew Gomes took charge of his health, changing his diet, exercising more, taking up yoga and meditating. Photo: Jonathan Wong

A balloon angioplasty procedure used to insert a stent in an artery. Illustration: Shutterstock

Gomes in the gym in his residential building in Hong Kong’s Mid-Levels. Photo: Jonathan Wong

Gomes cycles on three to four days every week. Photo: Jonathan Wong

Dr William Li’s book inspired Gomes to change his lifestyle. Photo: Amazon

Gomes follows a low-glycaemic index diet. Photo: Jonathan Wong

Gomes and his wife, Rekha, on a cycling trip in Hong Kong’s New Territories. Photo: Mathew Gomes

His journey to health inspired Gomes to embark on a new profession as an executive lifestyle and health coach. Photo: Mathew Gomes

The journey to good health, says Gomes, flourishes through a connection with nature, friends and family. Photo: Jonathan Wong

Lifestyle

Health & Wellness

Health

Andropause, a decline in testosterone levels, can lower sex drive, and reduce energy, muscle mass and strength, so how to combat ‘low T’?


Male menopause, or andropause, starts in their mid-thirties, when their testosterone levels begin to fall. Men can improve their level by exercising, getting quality sleep and maintaining a healthy weight, a doctor says.


How to age well

Ageing society

Disease

Reproductive health