Hormonal Aspects of Male Menopause

Over the years, researchers have tried to determine whether there is a male equivalent of the female menopause. As you know, the female menopause is the result of the ovary running out of eggs and being unable to produce the female hormones estrogen and progesterone. Investigators have evaluated the male testis to see whether it goes through the same kind of changes and whether it, like the ovary, reduces production of its sex hormone, testosterone.

The testis is to man what the ovary is to woman—a gland with two express functions: reproduction and hormone production. The most remarkable difference between them is that the man’s testis somehow maintains its ability to produce spermatozoa throughout life, whereas the woman’s ovary never produces a single new egg from the time she is born. So the healthy male is able to father children as long as he lives, and the female’s reproductive life ends at menopause. Was this apparent inequity nature’s way of protecting the species, assuring that a woman would live long enough to nurture her young inasmuch as she could only conceive while she had enough years left to care for them? Or is it simply an unfair quirk of nature whose purpose, if any, we do not yet understand?

There has been remarkably little good scientific evaluation of the change in male hormone production throughout the male life cycle. The best studies were conducted only in the last decade. The results suggest that the male hormone, testosterone, exhibits a characteristic pattern throughout a man’s life. Its levels first peak during the male’s intrauterine life, at about fourteen to sixteen weeks into the preg­nancy; then the level begins to drop. There is another brief peak after a boy baby is born; then the testosterone level drops and remains low until puberty. At that time there is a sharp increase in the blood level of testosterone that continues from puberty until a man is in his mid-fifties, or later. From then on, there is a slow decrease in testoster­one levels.

Another important aspect to consider is that both men and women have some hormone of the opposite sex circulating in their blood. So when the blood testosterone levels decrease in men, there is a relative increase in their estrogen levels as they age.

Investigators have found that in the older man, there is a decrease in the actual number of cells that produce sex hormones. However, there is very little data analyzing the sperm of men as they age. Generally, it seems that sperm counts remain unaltered. If we take into account that sexual activity slows down, then sperm production may actually be decelerating with age. Parallel with the decreased sperm production is a reduction in the sperm’s ability to move forward actively (motility) and to get to its destination.

Despite these changes, a man tends to remain hormonally and reproductively normal until he enters his late fifties, or even his early sixties. At that time, some changes occur in testicular function, but the process of change for the male is very slow, and there is no comparison with the abrupt changes that occur in women.

Another fact to consider in exploring the idea of whether or not men undergo a male menopause is that male life expectancy is shorter than that of the female, and the slight reduction in testicular function tends to occur in the last years of his life. Thus, a man is potentially virile and potent—if his health and all other aspects remain equal— until close to the end of life. So these changes are more subtle than a woman’s and often do not make serious inroads on a man’s life.

What Are Possible Symptoms of Male Menopause? What does occur when men are around middle-age? Findings have suggested that some older men complain of reduced libido or sexual potency, increased fatigue, decreasing productivity and concentra­tion, sweating, tachycardia (excessively rapid heartbeat), skin atrophy, sleep disturbances, anxiety, and depression. There also have been reports of male hot flashes! The clustering of these symptoms around the ages of forty-five through sixty ushered the phrase male climacteric syndrome into vogue almost fifty years ago.

The truth is that there is no such thing as the male climacteric syndrome when evaluated in hormonal or psychopathological terms. There are minor chemical changes that do occur but are relatively insignificant. In one study, 10,000 male outpatients claiming to be suffering from the male climacteric were evaluated statistically. No age-related increase in the frequency of depression, fatigueability, and decreased activity was found. The generally accepted conclusion is that certain symptoms do increase in men of advancing age, and these affect sex, memory, and sleep. However, they do not cluster between the ages of forty-five to sixty, but instead just continue to increase slowly with advancing age, and there is no justification for calling any syndrome the male climacteric. These changes are age-related, not sex-related. Since there are no menses, and therefore no cessation of menses in men, the term male menopause is not valid.