Male menopause (andropause): causes, symptoms & helpful interventions

Although testosterone levels naturally decline with age, research into the causes of low testosterone shows more and more men are suffering the effects of low testosterone and these increases are being seen in younger men too.^1-3 Testosterone levels in men have been in a slow and consistent decline for several decades now and are often related to a range of factors rather than ageing alone.^1-6 In this week’s blog we will look at some of the factors that may be contributing to this decline and some of the nutritional and lifestyle interventions that can help with male menopause.

Introduction to the male menopause (andropause)

The andropause refers to symptoms relating to the gradual decline in testosterone production in ageing men. The term ‘andropause’ however can be misleading as it suggests the symptoms are the result of a sudden drop in testosterone in middle age.⁶ The onset of the andropause is far less sudden than the menopause, which is characterised by a relatively rapid drop in oestrogen production. Testosterone levels, in contrast, tend to naturally decrease by around 1% per year after the age of thirty.⁷ This gradual decline may go unnoticed in many men but approximately 30% will experience some symptoms of the andropause.

The rate of decline and severity of symptoms varies in different individuals and hormonal declines may not always be the result of andropause alone. Testosterone levels can be affected by many factors either in addition to the andropause, independently, or collectively. These include poor sleep, chronic stress, medications, excessive alcohol intake, disease, obesity and poor diet.

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The role of testosterone in the body

Testosterone is a steroid hormone, which belongs in the group of androgens. Healthy levels of testosterone influence a broad range of health goals from maintaining healthy libido, sperm profile and mental alertness, to supporting athletic performance. It is therefore an important hormone and plays many roles in the body:¹

• Heart – increases cardiac output and peripheral and coronary blood flow
• Brain – responsible for sex drive, aids cognition, memory and emotions
• Muscle – increases mass and strength
• Skin – produces hair and sebum and supports collagen production
• Sex organs – responsible for sperm production, prostate health and erectile function
• Bone – helps to maintain bone density, growth and bone marrow production of red blood cells 

Symptoms of low testosterone

Given the wide-reaching role testosterone has in the body, decreased levels can initiate symptoms such as:

• low sex drive
• erectile dysfunction
• lack of energy
• depression
• irritability and mood swings
• loss of strength or muscle mass
• sleep disturbances
• increased body fat or fat redistribution
• hot flashes

Further complications of low testosterone

Adequate levels of testosterone are also important for overall health and a reduction in the risk of certain diseases. For example, complications associated with low testosterone include an increased risk of cardiovascular problems, diabetes, dementia and osteoporosis. In a 10-year study involving 3690 older men it was concluded that total and free testosterone levels in the normal range were associated with decreased all-cause and cardiovascular mortality.¹ Research also shows that low testosterone in combination with obesity can contribute to neuroinflammation, which is consistent with low mood and depression as well as a risk factor for cognitive issues such as dementia and Alzheimer’s.^2,3

Andropause pathophysiology

Reduction in hypothalamic-pituitary-gonad (HPG) function

As men age, there is a reduction of HPG function and subsequent Leydig cell function. Decreased testosterone can therefore be attributed to the age-related reduction in the number of Leydig cells in the interstitium of the testes, which are the primary producers of testosterone. 

Damage to Leydig cells

Additionally, the Leydig cells may become damaged or dysfunctional, or resistant to signals from the pituitary gland to produce testosterone. Inflammation and oxidative damage can be a factor at play here. 

Conversion of testosterone into oestrogen

The aromatase enzyme is responsible for converting testosterone into oestrogen by a process called aromatization. The aromatase enzyme is found in higher concentrations in fat tissue. Elevated levels of oestrogen can signal to the pituitary gland to reduce production of luteinizing hormone (LH), a hormone which signals to the testes to produce testosterone. 

Increased production of sex hormone binding globulin 

Sex hormone binding globulin (SHBG) is a protein which binds to testosterone and transports it around the body. This is important as it will direct testosterone to appropriate sites of action. However, when SHBG levels are too high, free testosterone is reduced and symptoms can be exacerbated. Factors that can increase SHBG include age and excess oestrogen. 

Drivers of male menopause

Many of the below drivers are interrelated. 

Obesity

There is a significant correlation between a high BMI and decreased testosterone and obesity is considered the single most common cause of testosterone deficiency in the developed world.¹ Men with a BMI greater than 30 have on average 30% lower levels of testosterone compared to men with a healthy BMI. This is likely due to:

• Adipose tissue produces the enzyme aromatase which converts testosterone into oestrogen
• Obese patients have elevated levels of serum leptin which leads to the disruption of the HPG axis and decreased production of testosterone from Leydig cells
• Adipose tissue secretes inflammatory cytokines and adipokines which have a negative influence on the function of the HPG axis 

Insulin dysregulation

There is an association between type 2 diabetes, insulin resistance and a decrease in testosterone levels. This, in part, may be due to:

• an increase in adipose tissue and therefore the above situation applies
• insulin resistance has a negative effect on the HPG axis and may disrupt testosterone regulation
• Those who are overweight, or have type 2 diabetes have an increased risk of developing late-onset hypogonadism which is a condition that has many of the same symptoms as the andropause.

Oxidative stress

Oxidative stress can contribute damage to Leydig cells, and therefore may contribute to low testosterone levels. This can be a vicious cycle as reduced testosterone can also induce oxidative stress and apoptosis. 

Inflammation

Poor diet, insulin resistance, obesity and oxidative stress can all contribute to inflammation in

the body. Other factors include excessive alcohol intake, stress and smoking. Many studies have linked testosterone deficiency with increased levels of inflammation in the body.^2,3 

Stress

Chronic stress can lead to HPA dysregulation and depressed pituitary function, which can lead to decreased levels of stimulating hormones that tell the Leydig cells to produce testosterone. Furthermore, elevated cortisol levels can disrupt blood sugar regulation. 

Endocrine Disrupters

Endocrine disrupting chemicals are oestrogen-like and/or anti-androgenic compounds that disrupt and interfere with the production, release, transport, or elimination of hormones.⁴ For example, exposure to high levels of chemicals such as phthalates have been found to block the effects of testosterone on the body.⁵  Excess oestrogen can increase SHBG. 

Sedentary lifestyle

Besides being detrimental to many other aspects of health, being inactive may also contribute to low testosterone. This is independent to being overweight, as inactivity is unhealthy for men of an ideal weight too. In one study, an increase in FSH and decreases in testosterone and the testosterone/LH ratio were detected in men watching with sedentary lifestyles.⁶

Medications

Certain medications may potentially affect testosterone levels such as statins, certain antidepressants and opioids.⁷ Steroid medications  are anti-inflammatory medications that are prescribed for a wide range of conditions and are commonly used in the population. They have however been associated with a reduction in testosterone.  

Nutritional and lifestyle interventions

Understanding the underlying mechanism(s) is key to supporting healthy testosterone levels. 

How to use to nutrition to support the male menopause (andropause)

Adopt a nutrient dense diet – the production of testosterone and its signalling pathways have many complex steps and require adequate nutrient levels to facilitate. Processed and refined foods have been stripped of many important nutrients and so adopting a diet which is rich in wholefoods, fruits and vegetables is recommended. Supporting a nutrient dense diet with a good quality multivitamin and mineral to ensure you are bridging the gap between intake and optimal needs is also an option. 

Follow an anti-inflammatory diet – reducing inflammation is also important as there is an association between inflammation and low testosterone.

• Reduce foods high in omega-6 – e.g. farmed meats, dairy products and vegetable oils. These are high in the omega-6 fatty acid arachidonic acid or linoleic acid (precursor to arachidonic acid). Arachidonic acid can be converted to the pro-inflammatory prostaglandin PGE
• Increase sources of omega-3 from oily fish, flax, and chia seeds. EPA is found in oily fish or can be supplemented. Alpha linolenic acid is found in flax, chia seeds and dark leafy green vegetables and can be converted to EPA by the body, although the conversion is not always efficient. EPA is converted into anti-inflammatory prostaglandins
• The ratio of omega-6 to 3 is very important. The majority of people are consuming too much omega-6 relative to omega-3 and are often producing excess amounts of pro-inflammatory prostaglandins 

Minimise oxidative stress – processed, refined foods and preservatives are some of the biggest dietary culprits of free radicals, which can cause oxidative stress in the body. Minimising these foods and increasing the intake of antioxidants can be beneficial:

• Consume 6-8 portions of vegetables and 1-2 portions of fruit per day which are high in antioxidants and phytonutrients – choose a wide range of colours
• Increase antioxidants such as vitamin A, vitamin C, selenium, zinc, N-acetyl-cysteine, alpha-lipoic acid and polyphenols

Address weight and blood sugar regulation – weight reduction and blood sugar regulation have been shown to be an effective intervention. This can be done by:

• Consuming low glycaemic load carbohydrates with protein and healthy fats to slow down blood sugar release
• Intermittent fasting, which reduces insulin levels. This can be achieved by ensuring caloric intake is below 500Kcal for 2 days out of 7, or ensuring food is only consumed in a maximum of a 12-hour window. Even more effective is an 8-hour window (e.g. 10am-6pm)
• Supplementing nutrients or herbs which aid glucose uptake and improve insulin sensitivity such as chromium, magnesium, zinc, alpha lipoic acid and cinnamon 

Support the adrenal glands – a small percentage of testosterone is produced by the adrenal glands, which are predominantly responsible for our stress response. Therefore, supporting adrenal function and stress management can help to support testosterone levels. Useful ways to support adrenal function include: 

• Nutrients such as vitamins B5 and B6, vitamin C and magnesium
• Adaptogenic herbs such as liquorice, ashwagandha and Siberian ginseng

Support healthy liver and detoxification pathways – it is not always possible to avoid endocrine disruptors and other toxins but there are steps you can take to reduce your toxic load: 

• Drink plenty of filtered water daily
• Eat cruciferous vegetables such as broccoli, cauliflower and cabbage
• Reduce consumption of processed foods and sugar
• Eat organic where possible
• Switch products that contain parabens
• Use non-toxic household products to clean the home
• Support the liver with herbs such as milk thistle
• Limit alcohol consumption
• Give up smoking 

Lifestyle changes to support andropause 

Exercise – a combination of cardiovascular and resistance exercise reduces the risk of many lifestyle-related diseases such as obesity and cardiovascular disease. Losing excess body weight can also help to reduce aromatase activity. Exercise can bring about noticeable improvements in bone density, fertility, heart health, as well as mood. Aim for 150 minutes of moderate to intense exercise per week – this will help to increases muscle mass, reduce adipose tissue and increases insulin sensitivity.

Sleep – it is beneficial to establish and maintain a regular sleep-wake cycle with adequate sleep. Testosterone levels and sleep typically work in harmony. During sleep, testosterone levels are replenished. Sleep deprivation or restriction can however cause testosterone levels to drop. One study involving 2,295 teenage boys and men found that impaired sleep could be linked to lower levels of testosterone.¹ Nutrients to support restful sleep include magnesium, vitamin B6, 5-HTP, L-Theanine and natural sources of melatonin such as Montmorency cherry.

Stress – relaxation techniques such as meditation, mindfulness, massage and yoga can help to support the adrenal glands, increase insulin sensitivity and minimise HPA dysregulation. 

Nutrients to support male health

Zinc – contributes to normal testosterone levels in the blood and protects cells from oxidative stress. It is important for the maintenance and health of the testes and contributes to normal fertility and reproduction. Zinc is required for spermatogenesis and adequate zinc levels in semen are essential for correct morphology, sperm count and function. Suboptimal zinc status appears to have a negative influence on serum testosterone concentrations. Zinc also contributes to normal carbohydrate metabolism. Including zinc-rich foods to help support testosterone production can help – these include oysters, seafood, legumes and pumpkin seeds. 

Vitamin B6 – contributes to the regulation of hormonal activity, is necessary for testosterone production and is supportive of adrenal function.

Vitamin C – contributes to the protection of cells from oxidative stress and can be found in very high concentrations within the semen. It also contributes to normal psychological function.

Selenium is an antioxidant mineral which contributes to the protection of cells from oxidative stress. Selenium also contributes to normal spermatogenesis.

Lycopene is a carotenoid found at high levels in tomatoes and is found in high concentrations in the testes and semen.

CoQ10 is found in high concentration within sperm cells, where it promotes motility, fosters sperm survival and provides optimum energy to assist the sperm’s travel to the oocyte. 

L-carnitine is found in high concentrations in the male reproductive tract and appears to encourage the production of testosterone. 

Please note, it is always advised to see a healthcare provider if you have any of the symptoms of low testosterone to rule out other potential causes.

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References

Introduction

1. Lokeshwar, S. D., Patel, P., Fantus, R. J., Halpern, J., Chang, C., Kargi, A. Y., & Ramasamy, R. (2021). Decline in Serum Testosterone Levels Among Adolescent and Young Adult Men in the USA. European urology focus, 7(4), 886–889.

2. Travison, T.G. et al. (2007) ‘A population-level decline in serum testosterone levels in American men’, The Journal of clinical endocrinology and metabolism, 92(1), pp. 196–202.

3. Why Are Testosterone Levels Declining? – Cleveland Clinic (2022). (Accessed: 12 December 2022).

4. Anaissie, J., DeLay, K. J., Wang, W., Hatzichristodoulou, G., & Hellstrom, W. J. (2017). Testosterone deficiency in adults and corresponding treatment patterns across the globe. Translational andrology and urology, 6(2), 183–191.

5. Perheentupa, A. et al. (2013) ‘A cohort effect on serum testosterone levels in Finnish men.’, European journal of endocrinology / European Federation of Endocrine Societies, 168(2), pp. 227–233.

6. Gryzinski, G.M. and Bernie, H.L. (2022) ‘Testosterone deficiency and the aging male’, International journal of impotence research, 34(7).

7. The ‘male menopause’ – NHS (2022). (Accessed: 8 December 2022).

Role of testosterone

1. 1 Hackett, G. et al. (2017) ‘UK policy statements on testosterone deficiency’, International Journal of Clinical Practice, 71(3–4), p. e12901.

Further complications

1. Yeap, B. B., et al (2014). In older men an optimal plasma testosterone is associated with reduced all-cause mortality and higher dihydrotestosterone with reduced ischemic heart disease mortality, while estradiol levels do not predict mortality. The Journal of clinical endocrinology and metabolism, 99(1), E9–E18.

2. Dean, J.D. et al. (2015) ‘The International Society for Sexual Medicine’s Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men’, The journal of sexual medicine, 12(8), pp. 1660–1686.

3. Research shows Alzheimer’s disease relationship with obesity and testosterone – The Statesman (2018). (Accessed: 9 December 2022).

Drivers

1. Corona, G. et al. (2015) ‘Obesity and late-onset hypogonadism’, Molecular and cellular endocrinology, 418 Pt 2, pp. 120–133.

2. Zhang, C. et al. (2021) ‘The Association between Dietary Inflammatory Index and Sex Hormones among Men in the United States’, The Journal of urology, 206(1), pp. 97–103.

3. Bobjer, J. et al. (2013) ‘Negative association between testosterone concentration and inflammatory markers in young men: a nested cross-sectional study’, PloS one, 8(4).

4. Jeng, H.A. (2014) ‘Exposure to Endocrine Disrupting Chemicals and Male Reproductive Health’, Frontiers in Public Health, 2(JUN).

5. Reduced Testosterone Tied to Endocrine-disrupting Chemical Exposure | Endocrine Society (Accessed: 8 December 2022).

6. Priskorn, L. et al. (2016) ‘Is Sedentary Lifestyle Associated with Testicular Function? A Cross-Sectional Study of 1,210 Men’, American Journal of Epidemiology, 184(4), pp. 284–294.

7. Schooling, C.M. et al. (2013) ‘The effect of statins on testosterone in men and women, a systematic review and meta-analysis of randomized controlled trials’, BMC medicine, 11(1).

Sleep

1. Patel, P. et al. (2019) ‘Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey’, World journal of urology, 37(7), pp. 1449–1453.

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If you have questions regarding the topics that have been raised, or any other health matters, please contact our team of Nutritional Therapists:

nutrition@cytoplan.co.uk
01684 310099

For further reading, you might also like: Human hormones and the seasons

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Last updated on 3rd January 2024 by cytoffice