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Researchers Identify Male Menopause Symptoms

Decreased Sex Drive and Fatigue Are Among Symptoms of Late-Onset Hypogonadism

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Wu and his team noted that the differences in testosterone levels between men with symptoms and men without “were marginal, highlighting the weak overall association between symptoms and testosterone levels.” Researchers also pointed out that their data collection about the patients’ symptoms were based on the patients’ recall, so there could be a potential bias.

Wu said there is a risk of overdiagnosing male menopause, a condition some critics say is just a part of the natural aging process and not a medical condition at all. It is estimated that hormone therapy has increased by 400% in the United States since 1999, though this spike in treatment has not been observed in other countries.

"The application of these new criteria should guard against the excessive diagnosis of hypogonadism and curb the unwise use of testosterone therapy in older men,” Wu said.

A U.S. study published last month in the International Journal of Clinical Practice reported a high prevalence of hypogonadism among older men and projected that this figure would increase given the fact that men are living longer into old age. The article also reported an association between male menopause and other chronic health problems, including obesity, type 2 diabetes, high blood pressure, osteoporosis, and metabolic syndrome, an endocrine disorder that can increase the risk of diabetes, heart disease, and stroke.

Christopher Saigal MD, MPH, an associate professor of urology at the University of California, Los Angeles, said one of the strengths of the study is that it is a general population study that is not focused on men seeking care for urology problems, such as erectile dysfunction.

“Many of the complaints ascribed to having 'low testosterone' seem as likely to be found in men with normal testosterone,” Saigal tells WebMD via email. “The authors found that some sexual symptoms and a lower self-reported vitality were consistently associated with low testosterone levels.”

Saigal said that it’s known that circulating testosterone decreases by about 1% per year in men after age 30, but whether this decline causes risks to one’s health or whether testosterone therapy would be beneficial or induce risk remains unknown.

“We still don't know how effective supplementation will be at ameliorating these, or the long-term risks of the medication, but we now have an evidence-based definition of men who might be helped,” Saigal said. “They must have specific symptoms as well as properly collected blood tests.”

"This article raises more questions than it answers," says Natan Bar-Chama, MD, associate professor of urology and associate professor of obstetrics, gynecology and reproductive science at The Mount Sinai Medical Center in New York City.

"It is essentially a statistical exercise with, in my opinion, limited clinical implications … Firstly, clear guidelines by the endocrine society exist and have been recently updated to diagnose hypogonadism (total testosterone of <300 ng /dl),” Bar-Chama says. “Is the linkage between fewer morning erections, fewer sexual thoughts -- reflecting a reduced sex drive -- and impotence with hypogonadism newsworthy? We have known this since testosterone was discovered.  Furthermore one may draw the incorrect conclusion, which is that by treating hypogonadism one would effectively cure erectile dysfunction.”

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