If someone were middle-aged and experiencing low energy, decreased motivation, trouble sleeping, changes in mood, a lack of sex drive, and hot flashes, they could be in menopause — regardless of their gender.
Nearly half of men experience ‘male menopause,’ also called late-onset hypogonadism, but the condition is under-diagnosed, according to newly-published pharmaceutical guidelines published by the University of Alberta.
Hypogonadism, which usually impacts men in their 50s, but can start as early as in their late 20s, involves a drop in testosterone levels that leads to a number of side effects — some which are very similar to those experienced by women in menopause, such as trouble sleeping and mood changes. Other common symptoms for men include difficulty getting or maintaining erections (especially those that happen in the morning), loss of facial or body hair and decreased testicle size.
As concerning as these symptoms are, many men wouldn’t necessarily recognize them as a drop in testosterone, says Dr. Cheryl Sadowski, a pharmaceutical sciences professor at the University of Alberta.
“Sometimes they think ‘Oh, this is just aging,’” she told Healthing, adding that sometimes if these men experience erectile dysfunction, “they blame the relationship [saying] ‘I’m in a bad relationship,’ and ‘I’m not sexually interested,’ when, really, it’s low testosterone.”
Of course, there are other possibilities for a lacking libido: medical conditions like depression can impact sex drive, for instance, as can some medications. But Sadowski recommends that anyone experiencing those symptoms should talk to a doctor who can test testosterone levels which are easy to check with a blood test, but aren’t typically included in standard blood work.
“Unlike menopause, not every older man… goes into hypogonadism,” she says. “A lab test will really only happen if a man has symptoms.” Another idiosyncrasy of testosterone levels: they need to be tested early in the morning, she says.
Treating ‘male menopause’
Low testosterone can be treated with testosterone replacement therapy. Since testosterone is a controlled substance with potential side effects, it has to be prescribed by a doctor — there’s an underground market for testosterone sales by bodybuilders, Sadowski says — but pharmacists can work with a patient’s doctor to manage their prescription.
Testosterone is also available in many forms, says Nathan Beahm, another U of A professor and co-author of the research. The most common are transdermal options — either a patch placed directly on the skin, or a gel that’s spread on the upper arms and shoulders, but it’s also available as a pill or an injectable liquid.
Trump and testosterone
While hypogonadism is still largely unknown by the general public, says Sadowski, she points to a brief 2016 Donald Trump-led interest in testosterone testing several years ago. The then-presidential candidate released his medical records and bragged about his testosterone levels in a televised interview with questionable TV doctor Mehmet Oz, in an appearance Vox called “surreal” and “disturbing.”
“There was a little blip, like ‘Oh, yeah, men should be tested,’” she says. “But I think because it was Trump, people figured, ‘Oh, that’s just crazy.’”
When Sadowski noticed that this lack of knowledge extendsed to the treatment guidelines for hypogonadism, which were often unclear, she — and several of her University of Alberta colleagues — wrote their own guidelines to raise awareness of the issue and help with treatment.
Men don’t talk about health
It can be hard for men to open up about health issues, or even prioritize their health. A 2019 Cleveland Clinic study found that 82 per cent of men try to stay healthy to live longer for friends and family who rely on them, yet only 50 per cent engage in preventative care. In fact, 72 per cent of men would rather do household chores, like cleaning the bathroom or mowing the lawn, than go to the doctor. And perhaps at the root of it all: 41 per cent of men were told as children that men don’t complain about health issues.
Beahm calls that kind of stigma “unfortunate” and “a barrier to care for some.” But he’s optimistic that more pharmacists will start these important conversations.
“One of the things we’re hoping to encourage with [these guidelines] we’ve developed is more pharmacists initiating those discussions with patients,” he says, to “hopefully empower them to normalize that discussion and let patients know it’s not something to be ashamed of, it’s a process that a lot of people experience, and that treatment can be very helpful.”
And while Beahm admits that the term “male menopause” isn’t a great one, and may lead to misunderstandings that it has a similar onset and treatment course [to menopause], the phrase may be an easier way to introduce the topic.
“Menopause is perhaps easier for people to understand than ‘late-onset hypogonadism,’” he says.