Do men go through a ‘male menopause’?

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Dr. J. Taylor Hays, M.D.

Menopause refers to the end of menstruation and fertility in women. It’s caused by a dramatic drop in production of the female hormone estrogen by a woman’s ovaries. There’s no equivalent in men.

But men do experience a hormonal change as they get older. Clear evidence indicates that they gradually produce less testosterone, the primary male hormone, throughout adulthood.

Even taking this age-related decline into consideration, the testosterone level of most men stays within what’s considered a normal range, and they don’t experience signs or symptoms.

However, if a man’s testosterone production clearly drops below normal levels, say, as the result of using medicine to treat prostate cancer, he may experience symptoms akin to menopause in women.

These might include hot flashes, fatigue, trouble sleeping, difficulty concentrating, and reduced sexual drive and performance. Erectile function may or may not be affected.

The underproduction of testosterone is called hypogonadism. In addition to prostate cancer treatment inducing this condition, hypogonadism can be inherited or result from a past injury or infection of the testicles. It also can occur simply with aging.

Hormone replacement therapy

Men who suspect they’re suffering from a low testosterone level should see their doctor. In addition to the symptoms described above, the condition can cause a decrease in muscle mass and loss of bone mass (osteoporosis), similar to postmenopausal women.

Some men who are diagnosed with hypogonadism can be helped with testosterone replacement therapy, which slows the loss of muscle and improves bone density.

Some people worry about the treatment’s potential side effects. They think of anabolic steroid use in athletes, for example, which can cause liver problems and male infertility.

But our primary concern with testosterone replacement therapy in older men is prostate growth and prostate cancer, because the prostate gland grows under the influence of testosterone.

While there’s not a great deal of evidence that patients who receive testosterone replacement therapy are at increased risk of prostate cancer, this possibility is an unresolved issue.

Testosterone replacement therapy can produce other unwanted side effects, however, including the development of obstructive sleep apnea and the overproduction of red blood cells in some men.

Because of these risks, those considering the therapy should be sure their doctor evaluates their symptoms, measures their blood cell count, examines their prostate, and checks their prostate-specific antigen (PSA) blood level.

In men whose testosterone still registers in the normal range, there is no evidence indicating that supplemental testosterone therapy is helpful. Also, research does not tell us if testosterone therapy improves muscle strength, muscle mass, or physical performance measurements.

A doctor can diagnose underproduction of testosterone with a simple blood test. A sample is usually taken in the morning after fasting and, typically, is measured on more than one occasion, because testosterone production can vary slightly from day to day.

A diagnosis of hypogonadism is based on the presence of symptoms suggesting low testosterone, and at least two or three abnormally low testosterone blood tests.

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