Dear Dr. G,

I am having a midlife crisis and I really need some help.

I am a middle-aged man reaching the age of 50.

My wife tells me in the last three years I haven’t been myself.

My libido is almost non-existent and truthfully, I cannot remember when was the last time I had sex with my wife.

Apart from the non-existence sex life, I am also constantly feeling tired.

I often noticed myself to be forgetful and short-tempered.

These are all quite out of character for me.

My wife suggested seeing the doctor and reckons it may be “male menopause”

I did go to the doctor and had a blood test.

After the check-up, he reckons I indeed have andropause.

Apparently, my high cholesterol, hypertension, diabetes and putting on weight is also responsible for my male menopause.

Now, I am all confused, and I would like to put Dr. G on the spot.

Is there such a thing as male menopause?

If so, how is it diagnosed?

What are the symptoms experienced with the condition?

The fact is, I just want my youthful energy and libido back, can I not just get quick fix testosterone replacements. Is there any risk?

Yours truly,
Quick-fix Quintin

The drop in male hormone production in aging men is often termed male menopause. This is associated with declining testosterone with diminishing testicular function, also termed hypogonadism.

The variations of the terminology for the condition are andropause, testosterone deficiency syndrome (TDS), Androgen Deficiency of the Aging Male (ADAM) and Late Onset Hypogonadism (LOH), all describing aging symptoms related to the declining hormone.

Hormonal changes are a natural part of aging for both women and men. In a woman, the end of ovulation results in a more dramatic plunge of the sex hormones, rendering a drastic emergence of symptoms.

On the other hand, the gradual decline in the male sexual hormone tends to be less drastic. This prompted the debate whether male menopause is real or just an urban myth.

However, long-term unhealthy lifestyle such as smoking, excessive alcohol consumption, overeating and lack of exercise is definitely associated with premature aging in men and perhaps the onset of “male menopause”.

The diagnosis of male menopause is not straightforward as testosterone levels differ greatly among men. In general, older men tend to have lower testosterone than in their younger days.

However, lower than normal levels of sex hormone do not always relate to adverse symptoms. Therefore, both medical history and laboratory investigations are crucial in making the diagnosis.

Apart from fuelling sex drive and physical energy, testosterone influences many aspects of a man’s life including mental and musculoskeletal health.

The decline of the hormone can lead to a barrage of symptoms. The most obvious change noticeable by men is low libido and even the emergence of sexual dysfunction such as erectile dysfunction (ED).

Many men also reported the shrinkage of their crown jewels resulting in a decline of fertility. Various bodily changes including truncal obesity, reduced muscle bulk, and decrease in bone density.

The loss of bodily hair and the emergence of “man boobs” are also common. Lastly, low testosterone is well-recognised to contribute to a decrease in motivation, insomnia, irritability and loss of self-confidence.

Lifestyle changes and the treatment of blood pressure, glucose and cholesterol are generally the first steps to revive the dwindling fountain of youth.

However, testosterone replacement therapy (TRT) can be a quick fix to restore the former glory. TRT is debated in medical literature and remains controversial for the treatment of male menopause.

Prolonged TRT in men may have several long-term adversities. The high levels of testosterone can result in the shrinkage of the testicles. Therefore, some men may experience irreversible shrinking sacs in the pants.

Reports of cardiovascular events such as heart attacks have also been reported, but, the true association is unclear. Serious complications such as prostate cancer is also linked to TRT in men, therefore stringent monitoring of the efficacy and adversity of therapy are crucial.

The decline of testosterone with advancing age in men does indeed put a damper on his fountain of youth. Years of indulgence in life and a sedentary lifestyle are well-recognised to be responsible for the dwindling hormone and drives inside and outside the bedroom.

Unhealthy lifestyles lead to the looming “menopause” threatening with shrinking testicles, beer bellies,”man boobs”, dwindling sex drives and deflated energy.

Although TRT is tempting for a quick fix, the sustained manner to reverse this aging process is simply a healthier way of life. Martin Luther King, Jr. once said: “Darkness cannot drive out darkness; only light can do that.”

When Dr. G is put on the spot by men who are tempted by the lure of TRT, his view is simply, “While careful replacement of testosterone can show you the light in the darkness of male menopause, only discipline and healthy choices of life can drive you out of darkness to ensure future life of Men-No-Pause!”

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