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Male Menopause Symptoms Officially Identified


Men, it’s okay to admit you are going through male menopause. Researchers have officially identified the symptoms associated with a reduction in testosterone in older men, although they say male menopause affects about only 2 percent of older males.

The link between the decline in testosterone levels seen in older men and late-onset hypogonadism (also known as male menopause) has long been a subject of debate. Now, for the first time, investigators have identified the symptoms of this condition and published their findings in the New England Journal of Medicine.

To establish the list of symptoms, the researchers, led by Dr. Fred Wu, a professor at The University of Manchester’s School of Biomedicine, surveyed a sample of 3,369 men aged 40 to 79 from eight different European centers. All the participants answered questions related to their general, sexual, psychological, and physical health.

Blood samples were collected from the men to determine their free and total testosterone levels. Free testosterone is the amount of the hormone present in the bloodstream that is not bound to protein. It comprises 2 percent of the testosterone in the body and is the biologically active form of the hormone. Total testosterone is the amount of both bound (and biologically inactive) and unbound testosterone.

The researchers selected three sexual, three physical, and three psychological symptoms they believe to be significantly linked with low testosterone levels. The three strongest indicators of male menopause were found to be in the sexual category: decreased frequency of morning erections, erectile dysfunction, and a decreased frequency of sexual thoughts. The lower a man’s testosterone levels, the more sexual symptoms he had.

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The remaining six symptoms were only weakly linked to low levels of testosterone: loss of energy, sadness, fatigue, an inability to walk more than 1 km, an inability to participate in vigorous activity, and an inability to stoop, bend, or kneel. Overall, Dr. Wu noted that male menopause is often associated with poor overall health and obesity.

The results of the new study have established that the definition of late-onset hypogonadism, or male menopause, is “the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter).”

Dr. Wu and his colleagues also ruled out certain symptoms that have been linked with male menopause in the past, but which did not show any significant link with low testosterone levels, including poor concentration, anxiety, nervousness, changes in sleep habits, feelings of worthlessness, and trouble getting out of a chair.

One reason for the interest in this condition is the 400 percent increase in the United States in the practice of prescribing testosterone therapy. However, Dr. Wu explained that this hormone treatment “may only be useful in a relatively small number of cases where androgen deficiency is suspected,” because they found that many of the symptoms of hypogonadism were not associated with low levels of testosterone in older males.

Although this study resulted in the identification of symptoms of male menopause, Dr. Wu cautioned that it is still a difficult condition to diagnose. He emphasized the importance of identifying all three sexual symptoms from the nine he and his colleagues identified as being indicative of male menopause, plus the presence of low testosterone, in making a diagnosis. If clinicians apply these new criteria, he believes this should help prevent against excessive diagnosis of male menopause and limit “unwise use of testosterone therapy in older men.”

University of Manchester, news release June 17, 2010