This week brought reports that “male menopause” policies are in place at several NHS trusts, with some HR managers suggesting staff could receive up to a year of sick pay if they experience symptoms. This is despite the NHS itself saying male menopause is not a clinical condition and that it is not national NHS policy to offer leave for it.
We take a look at the science behind the term.
What is meant by the “male menopause”?
The male menopause, also known as the andropause, is a term often used to refer to a cluster of features seen in some men in their late 40s to early 50s, such as depression, loss of sex drive, mood swings, erectile dysfunction, problems sleeping and loss of muscle mass.
However the NHS notes this is not a clinical condition. Rather, it says, it is an “unhelpful term sometimes used in the media”.
So this isn’t a male version of what women go through?
In a word, no.
Dr Ravinder Anand-Ivell, associate professor of endocrinology and reproductive physiology at the University of Nottingham and an expert of the European Academy of Andrology, says that the two are quite different.
“The menopause represents acute symptoms caused by the relatively abrupt cessation of ovarian hormonal function due to the exhaustion of a woman’s egg reserve at around 50 plus [or] minus five years of age,” she said. “Men have no equivalent physiology.”
Prof Richard Sharpe, an expert in male reproductive disorders from the University of Edinburgh, agreed.
“There is no question that, in normal men at the population level, blood testosterone levels decline with age from late 30s to early 40s onwards,” he said. “However, there is no precipitous fall in [blood testosterone] levels akin to that which occurs for estrogen levels in women at the menopause.”
Sharpe also stressed that some men may experience little blood testosterone decline when ageing. “It can be quite variable between individuals – unlike the 100% occurrence of menopause in women,” he said.
Does that mean the “male menopause” is made up?
“There is a condition in some elderly men, known as ‘late onset hypogonadism’ or more recently called ‘functional hypogonadism’, which is characterised by low concentrations of testosterone in the blood together with symptoms of testosterone deficiency such as loss of libido, bone and muscle weakness, etc,” said Anand-Ivell.
But, she added, this occurs in approximately 2.1% of men, almost exclusively over the age of 65.
While some men with late-onset hypogonadism (LOH) may benefit from testosterone replacement therapy, its wider use has caused controversy. Some experts have raised concerns that it is being given to patients who have some similar symptoms to LOH but may have blood testosterone levels within the normal range for that age group.
“This is what I refer to as a ‘charlatan’s charter’; as such, general symptoms will occur in most men during – and before – ageing, but are almost always driven by other factors,” said Sharpe.
So what is behind this cluster of symptoms?
Anand-Ivell said men who reported sudden symptoms, and at a younger age, might well be experiencing another underlying health problem.
Indeed, as the NHS notes, features that have been ascribed to a “male menopause” could be down to lifestyle factors or psychological problems.
“For example, erectile dysfunction, low sex drive and mood swings may be the result of stress, depression [or] anxiety,” the NHS says, adding other causes of erectile dysfunction include smoking or heart problems.
Financial and life worries may also play a role in the symptoms some men experience during ageing, as could poor diet, lack of sleep and low self-esteem, the NHS notes.
Sharpe added that conditions such as obesity, and its downstream disorders, were also generally associated with lower blood testosterone levels in men, with some arguing it might predispose them to further weight gain.
As for treatment, Prof Frederick Wu of Manchester Royal Infirmary said the approach was threefold: “Lifestyle change, weight loss and improve general health,” he said.
Why is the male menopause getting attention?
Experts say a key reason the “male menopause” is a hot topic is money.
Anand-Ivell said: “A lot of the ‘andropause’ literature stems from commercial interests, particularly in the USA, wishing to draw spurious comparisons with the female menopause in order to sell testosterone-related products for which there is no clinical evidence of benefit.”
The latest headlines, meanwhile, have been fuelled by the revelation that male menopause policies are in place at several NHS trusts. Sharpe said: “For myself, I am amazed that any health board would even talk about there being an andropause, let alone suggesting time off.”