Men's health

Hormone changes are a natural part of aging. But they differ between men and women. In women, reproductive hormones drop dramatically. In men, the drop in hormone levels happens slowly. Here's what you need to know.

Debunking the male menopause myth

The term "male menopause" has been used to describe decreasing testosterone levels related to aging. But aging-related hormone changes differ between women and men. In women, ovulation ends, and hormone production falls over a fairly short amount of time. This is called menopause. In men, the production of testosterone and other hormones goes down over many years.

This gradual fall of testosterone levels is called late-onset hypogonadism. Sometimes it’s called age-related low testosterone. Not everyone with age-related low testosterone has symptoms. Its long-term effects also aren't clear.

Recognizing low testosterone levels

Men’s testosterone levels generally fall about 1% a year after age 40. But most older men still have testosterone levels within the standard range. Only about 10% to 25% of men have levels thought to be low.

Low testosterone levels in older men often go unnoticed. A blood test can check testosterone levels. But tests aren't often done. And many men who have low testosterone levels have no symptoms. Also, the signs and symptoms related to low testosterone aren't specific to low testosterone. A person's age, medicines or other conditions also can cause symptoms. For example, having a body mass index of 30 or higher can cause symptoms like those of low testosterone.

Symptoms that suggest low testosterone include:

• Lowered sexual desire and activity.
• Erectile dysfunction or decreased erections.
• Breast tenderness or swelling.
• Infertility.
• Height loss, low-trauma broken bones, called fractures, or low bone mineral density.
• Hot flashes or sweats.

Other possible symptoms include having less energy, motivation and confidence. Some men feel depressed and have trouble focusing. It's also possible to have a rise in sleepiness and sleep disturbances. Symptoms can include mild unexplained anemia, lower muscle mass and strength, and more body fat.

Experts suggest only testing older men for low testosterone if they have symptoms. If the first test shows low testosterone, experts suggest repeating the test to confirm the results. Your healthcare professional may look for conditions that can cause low testosterone:

• Obstructive sleep apnea.
• Obesity.
• Stress from a serious illness, surgery or staying in the hospital.
• Medicines such as opioid pain relievers.

Treating these conditions can return testosterone levels to the regular range.

If you have low testosterone, you’ll likely have more testing of the pituitary gland. The pituitary gland is a kidney bean-sized gland that sits at the base of the brain. It is part of the body's endocrine system. This system includes all the glands that make and control hormones. Healthcare professionals use pituitary gland testing to help find out whether the low testosterone is due to aging. Testing also can rule out low levels of other hormones.

Treatment recommendations for older men with low testosterone

Recommendations on testosterone therapy for men with age-related low testosterone vary.

In 2020, the American College of Physicians recommended that healthcare professionals think about starting testosterone treatment in men with sexual dysfunction who wanted to improve their sexual function, after explaining the risks and benefits. In 2018, the Endocrine Society recommended testosterone therapy for men with age-related low testosterone who have symptoms related to low testosterone.

Some experts also recommend offering testosterone treatment to men with age-related low testosterone who have no symptoms.

If you choose to start testosterone therapy, your healthcare professional talks with you about the different ways you can take it. You may also talk about target levels and the need for follow-up testing.

For some men, testosterone therapy eases bothersome symptoms of low testosterone. For others, the benefits aren't clear. There are possible risks, too.

Though more research is needed, testosterone therapy might raise the risk of prostate and breast cancer. Testosterone therapy also has been linked to blood clots in the veins. It also may raise the risk of heart attack and stroke, but more research is needed.

Your healthcare professional may tell you not to start testosterone therapy if your fertility is likely to be important in the near future. Other reasons your healthcare professional may recommend against testosterone therapy include:

• History of breast or prostate cancer.
• Untreated severe obstructive sleep apnea.
• Uncontrolled heart failure, which lowers the heart's ability to pump blood.
• History of blood clots in the legs or lungs.
• Recent heart attack or stroke.

If you think you might have low testosterone, talk with your healthcare professional about your symptoms, testing and possible treatments. Your healthcare professional can help you weigh the pros and cons of treatment.