The terms ‘manopause’, ‘andropause’ or ‘male menopause’ make for snappy headlines. But they also make a mid-life hormonal dip sound just as inevitable for men as it is for women - something that isn’t the case.
For women, oestrogen takes a sudden nosedive once the ovaries have ceased their production of eggs. In men, testosterone levels decline slightly with age, but most ageing men still show a testosterone concentration akin to that of young men.
Yet many men in their late 40s to mid 50s do report symptoms of low vitality, weight gain, erectile dysfunction, loss of libido and even depression. So if declining testosterone levels aren’t to blame for the symptoms of the ‘manopause’, what else could be going on? We asked our wellness expert Gideon Remfrey to find out all the answers.
Does the male menopause actually exist?
While it is hard to find conclusive evidence to support the claims that men undergo a mid-life hormonal change similar to women’s menopause, there is plenty of research and documented case studies indicating that a significant number of men experience both psychological and physiological difficulties related to ageing specifically around their 40s to 50s.
Symptoms of the male menopauseCommonly reported physical and mental symptoms include:
- Fatigue or low energy
- Mood swings and irritability
- Poor sleep
- Low sex drive and erectile dysfunction
- Muscle atrophy or loss of skeletal muscle mass
- Increase in subcutaneous body fat, specifically in the mid-section and chest, known as gynaecomastia (or in headline terms, belly fat and man boobs).
While each of these signs are challenging enough on their own, many men report a cluster of symptoms which affects their everyday wellbeing, health and happiness.
Do male testosterone levels decline at mid-life?
The ‘manopause’ is commonly thought of as an age-related fall in testosterone. But while the majority of studies do show a slight and gradual decline in the total levels of testosterone in aging men, the findings are often confounded by other plausible explanations, ranging from ethnicity, the health of participants, weight gain/obesity, the study group selection and even genetics.
So while there does appear to be a slight decline in testosterone, it is important to realise that testosterone concentration in most ageing men remains well within the range of that of young men.
Can medical conditions cause low testosterone?
The andropause is different from the medically recognised conditions of primary and secondary hypogonadism, both of which may be congenital or caused by infection or injury.
Primary hypogonadism can occur at any age and the problem originates in the testes themselves which are found to produce very low or no sex hormones at all.
Secondary hypogonadism indicates a problem with the brain’s master controller glands, the hypothalamus and pituitary. The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). LH then signals the testes to produce testosterone. If this regulation becomes disordered, it may result in lowered sex glands function and subsequently insufficient amounts of sex hormones.
How do you know if you’ve got low testosterone?
To explore whether symptoms such as low libido, low energy or depression are related to lowered levels of circulating hormones, it helps to understand testosterone in a little more depth and find out exactly how it is medically tested.
Testosterone levels are synchronised by our circadian rhythm or wake/sleep cycle. They’re generally highest in the morning making this the ideal time to take a serum blood test. Rather than just testing the total testosterone in the blood, a male androgen hormone blood test (also referred to as a Free Androgen Index) may test various markers related to testerone and include factors that support or hinder its production.
For example, testosterone represents the total testosterone in the blood, but because it’s affected by so many other factors, this may not represent the complete picture. Sex hormone binding globule (SHBG) are proteins within the blood that bind to the male hormones (androgens), making them less available.
A combination of the first two results enable a calculated level of free testosterone, which represents the active amount of free-to-use testosterone (or testosterone unbound by the proteins albumin or SHBG).
Then, levels of estrogen steroid hormones may also be considered. Estradiol is essential for libido, erections and sperm function, but high levels can potentially cause symptoms associated with ‘manopause’ like erectile dysfunction, female fat deposits and infertility.
There may also be investigation into other markers that affect production of hormones via the adrenal glands such as 17-hydroxyprogesterone and androstenedione
So, as you can see, male hormone levels are complicated, and manopause symptoms may not be caused by something as clear cut as low testosterone. In summary, free testosterone appears to be important for male health but levels may be affected by:
- Proteins which bind to it, making it less active
- Higher levels of estrogen hormones
- A problem with the communication mechanism between the brain and adrenal glands which supports testosterone production.
Which lifestyle factors can impact male hormone levels?
This leads us to the whys, and investigation into the stressors that may contribute to male hormone dysregulation. Some stressors like age, genetics and ethnicity cannot be changed, but others are within our control.
Top 10 modifiable hormone stressors
1. Obesity, mid-section adiposity and decreased muscle mass
2. A poor diet
3. Disease: cardiovascular, diabetes, hypertension etc
3. Lack of both daily physical activity and planned exercise
4. Mental stress: work, relationships, low mood and self-esteem
5. Poor sleep: both duration and quality
6. Physical stress: manual work, excessive exercise
7. Drinking too much alcohol
Is oxidative stress to blame for the ‘manopause’?
Interestingly, all these chronic lifestyle stressors are also known to cause something called ‘oxidative stress’.
We have 370 trillion cells which act as the building blocks of our bodies. Left unchecked, oxidative stress causes excessive generation of reactive oxygen and chronic inflammation (cellular damage). Ultimately oxidative stress breaks down the DNA and affects our cells’ health-building capabilities. The good news is we can address chronic stress to support cellular health, which ultimately leads to healthy male ageing.
The three keys to optimal male vitality as you age
Here are three ways to combat chronic oxidative stress and support healthy hormone regulation, for optimal male vitality as you age.
1. Resistance training
Getting stuck into some regular lifting could offer a cheap and easy way of bolstering healthy male hormones, while promoting a few extra muscles to boot!
Resistance training supports healthy ageing by maintaining valuable skeletal muscle mass, strength and mobility, all of which decline as we get older. Further research indicates that maintaining skeletal muscle mass as a valued method of supporting anabolic (muscle building) signalling pathways, including testosterone.
As further motivation, resistance training increases our metabolism, lowers risk of diabetes and improves fat loss mitigating three further risks that may impair optimal male health.
To get the best results it is recommended to strength train two to four times per week for 30–50 minutes in duration and, from experience, finding exercise that you like doing is key!
Resistance training comes in many forms, from basic load-bearing exercise like walking with a weight vest, to more skill based methods of body weight/gymnastic type exercise, right through to traditional body building type weight training (hypertrophy).
Consider investing in a coach, for the short term at least. This will enable you to master technique and skills while you build your strength, something that helps with both long-term success and enjoyment.
2. Gut health
Improving our gut health and specifically the amount and diversity of our good gut bacteria (microbiota) has shown great promise in improving our immunity, digestive health and even our mood. But does it have any benefits for male menopause symptoms?
Both animal and human research show the potential benefits of probiotic strains to improve various issues of male aging. Studies on specific strains like L. reuteri have shown a viable and natural approach to the prevention of male hypogonadism.
Research also suggests the potential benefits of ageing men using probiotic therapy to improve their male hormones, testicular and reproductive fitness, to levels more typically seen in much younger healthy individuals.
There has also been promising research on probiotic use for athletic performance, with results that range from:
- Improved body composition
- Increased lean body mass
- Normalising age-related declines in testosterone levels
- Reductions in cortisol levels
Probiotic supplements can be helpful, as can improving diversity of the foods in your daily diet (particularly colourful plant foods).
Our natural wake/sleep cycle tightly governs all our bodily functions, including the production of important hormones such as testosterone and cortisol. Both are naturally highest in the morning and lower at night when we sleep.
Regular disruption to the length or quality of our sleep has been shown to negatively impact everything from our appetites and weight, to our gut microbiota and immune systems.
Lack of sleep can affect our hormone regulation, neurotransmitters linked to mood and cause Increases in oxidative stress - which also happen to be commonly reported symptoms of the manopause!
In simplistic terms the circadian system is organised around the brain’s 24-hour biological clock which is primarily driven by light. We biologically wake up to the sunlight and unwind in synchronicity with the sun setting.
Studies have shown however, that our modern living environment may be part of the problem. We are exposed to less light during the day and more artificial light at night. This may impair the biological clock, daily rhythm and disrupt sleep all of which contribute to increased calorie intake and reduced energy expenditure.
Using the following tips to regulate your circadian rhythm may also improve your manopause symptoms:
Try to wake up at the same time daily and add a morning walk into your routine. This exposes our eyes to natural blue light which supports the waking up of our biological clocks, increasing feel-good neurotransmitters like serotonin. The walk will also up your daily steps, helping to increase your calorie output.
Reduce the amount of artificial blue light you’re exposed to at night by cutting down on tech time or turning on your device's blue light filters. You can also buy circadian bulbs to light your home. These steps help de-stimulate your central nervous system while promoting the neurotransmitter melatonin, helping you wind down and reducing oxidative stress
Consider circadian eating. Modern life has extended the hours in the day that we consume calories, something that’s compounded by a reduction in our energy output. Shortening your daily eating window to 10 hrs (predominantly during sunlight hours) ensures more calories are consumed earlier in the day when required for energy rather than at night when winding down into inactivity. Studies also suggest a positive impact by reducing late night eating on glucose control, obesity/fat gain and improving satiety hormone leptin.
Don’t just live longer, live stronger!
The jury may be out on what’s really behind the manopause, but mid-life symptoms such as weight gain, fatigue and low energy are incredibly common and can severely impact men’s lives. It’s important we carry on an open conversation to support men through conditions that are often not discussed due to the stigma surrounding them.
Testosterone levels aside, what seems clear is that chronic mental and physical stress results in oxidative stress. Like the rust in our cars, left unchecked oxidative stress can corrode our bodies over time.
The good news is our bodies are resilient. Given the right nourishment, activity and rest, we can affect meaningful change in our health and vitality. Developing healthier habits requires a level of commitment. However, motivation and intention are powerful bedfellows when it comes to men improving their physical and mental health, boosting their happiness and reducing manopause symptoms.
“Aging is not ‘lost youth’ but a new stage of opportunity and strength.” Betty Friedan
If you enjoyed reading this article, you might like Introducing Inessa’s New Guest Contributor – Gideon Remfry.
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