Bespoke Health & Wellness
Men’s Health
Patient Guide

Understanding Andropause: Changes in Men's Bodies and Hormone Replacement Therapy

Andropause, also known as male menopause or late-onset hypogonadism, refers to a natural decline in testosterone levels that occurs in aging men. Unlike menopause in women, which involves a complete cessation of reproductive function, andropause is characterized by gradual hormonal changes that can affect various aspects of men's health. Below, we’ll explore the natural course of changes in men's bodies during andropause, the difference between andropause and clinical hypogonadism, and the role of hormone replacement therapy (HRT), including its risks, benefits, and contraindications.

The Natural Course of Andropause:

• Hormonal Changes: Testosterone levels gradually decline with age, typically starting in a man's late 40s or early 50s. This decline may be gradual or more rapid in some individuals and can lead to symptoms such as reduced energy levels, decreased libido, erectile dysfunction, decreased muscle mass, increased body fat, and mood changes.

• Symptoms of Andropause: While not all men experience symptoms of andropause, those who do may notice changes in physical, sexual, and psychological well-being. These symptoms can vary in severity and may have a significant impact on quality of life.

• Health Risks: Low testosterone levels in men have been associated with an increased risk of various health conditions, including osteoporosis, cardiovascular disease, metabolic syndrome, and depression. However, it's important to note that not all men with low testosterone will develop these conditions, and other factors may contribute to their development.


  Difference Between Andropause and Clinical Hypogonadism:

  Andropause is often used interchangeably with the term "male menopause," but there are important distinctions between these concepts. Andropause refers to the natural decline in testosterone levels that occurs with aging and is considered a normal part of the aging process. Clinical hypogonadism, on the other hand, refers to a medical condition characterized by abnormally low levels of testosterone and symptoms of testosterone deficiency.

Role of Hormone Replacement Therapy (HRT):

Hormone replacement therapy (HRT) involves the use of testosterone to restore testosterone levels in men with symptomatic hypogonadism or low testosterone levels associated with aging. Here are some key considerations regarding HRT for andropause:

Benefits:

• Symptom Relief: HRT can alleviate symptoms associated with low testosterone levels, including fatigue, low libido, erectile dysfunction, mood changes, and decreased muscle mass.


• Improved Sexual Function: Testosterone replacement therapy may improve sexual function, including libido, erectile function, and overall sexual satisfaction.


• Potential Bone Health Benefits: Testosterone plays a role in maintaining bone density, so HRT may help prevent osteoporosis and reduce the risk of fractures in men with low testosterone levels.


  Risks:

• Potential Cardiovascular Risks: Some studies have suggested a possible link between testosterone therapy and an increased risk of cardiovascular events, such as heart attacks and strokes. However, the evidence remains inconclusive, and more research is needed to fully understand the cardiovascular risks associated with HRT.


• Prostate Health Concerns: Testosterone replacement therapy may stimulate the growth of prostate tissue and potentially exacerbate benign prostatic hyperplasia (BPH) or increase the risk of prostate cancer. Regular monitoring of prostate health is essential during HRT.


• Polycythemia: Testosterone therapy can stimulate red blood cell production, leading to an increase in hematocrit and hemoglobin levels. This may increase the risk of polycythemia, a condition characterized by elevated red blood cell counts.


  Contraindications:

  HRT may not be suitable for all men, and certain contraindications should be considered before initiating therapy:

• Prostate Cancer: Testosterone replacement therapy is contraindicated in men with prostate cancer or a history of prostate cancer due to the potential for disease progression.


• Severe Lower Urinary Tract Symptoms: Men with severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) may be at increased risk of urinary retention or worsening symptoms with testosterone therapy.


• Breast Cancer: Testosterone therapy is contraindicated in men with breast cancer or a history of breast cancer due to the potential for disease recurrence or progression.


  Conclusion:

  Andropause is a natural phase of life characterized by declining testosterone levels and various symptoms that can impact men's health and well-being. Hormone replacement therapy may be an option for men with symptomatic hypogonadism or low testosterone levels associated with aging, but it's essential to weigh the potential risks and benefits of therapy carefully. Close monitoring by a healthcare provider is necessary to ensure the safety and efficacy of hormone replacement therapy for men experiencing symptoms of andropause.