Not the man you used to be?

"Suddenly, I'm not half the man I used to be..." If the words to that Beatles song make a lot more sense to you now than they did when you heard it as a teenager, there may be more to your newfound understanding than the wisdom of years.

As men get older, testosterone levels in the body gradually become lower than in the days of your youth, when you probably felt like you had the drive and energy to tackle just about anything that came your way. Testosterone is the hormone responsible for such typically "male" characteristics as deep voices, muscle mass, and facial and body hair patterns. A shortage can spell tiredness, low sex drive, loss of strength, increased body fat, and a slew of other effects that may make you feel old beyond your years. Because these symptoms appear slowly and are somewhat vague, a diagnosis of andropause can be easily missed.

Starting at the age of 30, men experience a drop in testosterone by about 10% every decade, while amounts of the hormone that are still being manufactured may not be as effective because of increased production of another hormone called SBHG. For some men, this decrease in testosterone results in a condition called andropause, which has a range of symptoms, including:

  • low sex drive
  • difficulties getting erections or erections that are not as strong as usual
  • lack of energy
  • depression
  • irritability and mood swings
  • loss of strength or muscle mass
  • increased body fat
  • hot flashes
  • restlessness and difficulty concentrating
  • generalized aches and pains

While many men think it's inevitable, feeling "down in the dumps" is not a necessary part of getting older. An estimated 4 to 5 million men in the US and 400,000 to 500,000 in Canada suffer from symptoms related to testosterone deficiency, but only about 5% are treated. Aside from the fact that that leaves a lot of men who simply aren't feeling as good as they should, it also puts a high number at risk for osteoporosis, or a weakening of the bones, and cardiovascular problems such as atherosclerosis and hardening of the arteries - both of which are conditions associated with low testosterone. Additional long-term effects of andropause include obesity, muscle loss, and erectile dysfunction.

But there's no reason for this condition to get so many men down! Doctors can easily diagnose low testosterone with a simple blood test, usually best performed in the morning. If levels come back low, further testing, including more blood tests, taking a sample of tissue from the testicles (called a biopsy), semen analysis, or brain imaging may be required. Once low testosterone is diagnosed, there are a number of different treatment options.

The "male menopause" myth

There's no doubt both sexes experience a "change of life" in some form sometime in their 40s or 50s. But that doesn't mean that this change is the same for both sexes. Though andropause is often referred to as "male menopause," there are actually a number of differences in the effects of aging on men's and women's hormones and on their bodies.

But before we focus on the divide between the sexes, let's look at the similarities - or at the least the similarities that have to do with the effects of aging! Both men and women experience a drop-off in sex-related hormone levels as they age, which can cause a number of changes in the body.

In women, the decrease and eventual stop in production of the "female" hormones estrogen and progesterone causes menopause, which is marked by the end of menstrual periods. This results in some symptoms similar to those of andropause.

Like andropausal men, women going through menopause may experience hot flashes, low sex drive caused by both emotional and physical changes, weight gain, irritability, and depression. Like their male counterparts, women going through this "change of life" are also at an increased risk for osteoporosis and cardiovascular disease.

Looking at those symptoms, it may seem that men and women are actually pretty similar - at least in this case. But there are a number of key differences between andropause and menopause.

For starters, menopause literally means the end of menstruation, while there is no such specific signpost to characterize the condition for andropausal men. Secondly, women experience a much faster drop-off in hormone levels than men do as they age - testosterone decreases gradually over decades, while the onset of menopause is relatively short.

As well, while some of the symptoms of menopause may vary from woman to woman, all females do stop getting their menstrual periods. In contrast, though all men will experience a decrease in testosterone production, not all men will have a big enough drop to cause any physical symptoms.

Why age gracefully?

Just because low testosterone has got you down, it doesn't mean that the down-in-the-dumps feeling and all the physical symptoms that come with it are something you have to put up with. Testosterone replacement therapy, which is available in a number of forms, has been shown to increase energy levels, muscle mass, bone density, and sex drive and to reduce other symptoms in men who suffer from low testosterone for a range of reasons.

Testosterone supplements come in a variety of forms, including gels, injections, patches, and pills. Men concerned about maintaining an active lifestyle may find it easiest to go with the patch because it is applied once daily to the back, abdomen, thigh, or upper arm and worn for 24 hours, and users can exercise, swim, bathe, and shower like normal. Most importantly, the patch is the only delivery method that mimics the natural daily rhythm of testosterone production in healthy young men.

While gels are also popular, they can be messy and restrictive. The gel is applied once daily to clean, dry and unbroken skin on the shoulders, upper arm, or abdomen, and users must wait several minutes for the gel to dry before dressing and a further 5 to 6 hours before showering, bathing, or swimming. Because the testosterone in the gel is so easily absorbed, men using this form need to take caution not to let anyone else come into direct contact with the medicated skin - this can lead to the other person developing masculine features such as a low voice and facial hair unless the affected area is washed thoroughly and as promptly as possible with soap and water.

Though they are available, pills are not commonly prescribed as a means of treating low testosterone because they can cause severe liver damage. And while some doctors may prescribe testosterone injections, the shots are injected directly into a muscle - which can be painful - and are generally administered at the doctor's office every 3 to 4 weeks, which may be inconvenient.

Side effects of testosterone replacement therapy can include acne, prostate growth, sleep problems, increased blood cell production, and other effects that are related to the specific dosage form. As well, men with prostrate cancer, breast cancer or allergies to testosterone or any ingredient in the dosage form should avoid testosterone replacement therapies.

Talk with your doctor to find out whether testosterone replacement therapy - and in which form - is right for you!

Live young, feel younger?

While researchers have yet to find the elusive fountain of youth, there are some lifestyle changes you can make to help reduce the symptoms and risks of andropause and bring you back up to the way you used to feel 10 years ago.

  • exercise: Regular exercise can help you control your weight, improve your mood and energy levels, and increase muscle and bone mass - which is key to preventing osteoporosis. You should do muscle and bone strengthening activities at least twice a week. Whether you are just starting out or have been exercising for years, try to make fitness a regular part of your routine. Your goal should be to exercise for at least 10 minutes at a time. Aim to complete at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity each week. Do a combination of activities that will get your heart pumping and your muscles working. Check with your doctor before starting a new exercise program.
  • healthy diet: Eating well doesn't have to be complicated, but getting the foods you need will help raise your energy levels, make it easier to maintain your weight, and help cut your risk of disease. Follow Eating Well with Canada's Food Guide to ensure that you are getting the proper balance of energy, protein, carbohydrates, and fat, and make sure to eat a colourful variety of plant-based foods. Because andropause can put men at risk for osteoporosis, make sure you get enough calcium and vitamin D in your diet. Men under the age of 50 should aim for 1,000 mg of calcium and 400 to 1,000 IU of vitamin D daily, while men over 50 need 1,200 mg of calcium and 800 to 2,000 IU of vitamin D a day.
  • quitting smoking: Though the reason is unclear, smoking has been shown to increase bone loss. It also puts you at an increased risk for heart disease. Talk to your doctor about a strategy for quitting.
  • counselling: If low testosterone has you feeling depressed, psychological counselling may help you manage your moods. Talk to your doctor about whether counselling, antidepressants, or a combination of both may help.