May 25, 2021
Though men do not undergo the dramatic drop in sexual hormones that women experience during menopause, they do go through a natural hormone decline, and it can have some surprising effects on their health.
Hypogonadism is when the sex glands — the testes in men and the ovaries in women — produce very little hormones. While autoimmune disorders, obesity, kidney and liver disease, and genetic disorders can cause it, a decrease in hormone production is also a natural part of aging.
During menopause, a woman's ovaries are no longer consistently producing the same levels of the hormones estrogen and progesterone. This leads to the cessation of menstrual periods and other symptoms including vaginal dryness, hot flashes, trouble sleeping, night sweats, mood changes, weight gain, dry skin and thinning hair.
As men age, their testosterone levels drop, but the effects of this decline is not as well understood as the effects of menopause in women. According to the Cleveland Clinic, testosterone not only helps maintain sexual and reproductive function, but also muscle mass, red blood cell levels and bone density.
Low testosterone affects almost half of men age 45 and older. However, doctors are still not sure what constitutes normal levels of this sex hormone because it can fluctuate during the day and be affected by body mass index, alcohol consumption, medication, illness and age.
The natural decline in testosterone begins after the age of 30 and will continue throughout a man's life, experts say. It is a gradual decline though, about 1-2% per year.
The most common symptoms of low testosterone are a low sex drive, erectile dysfunction, depression, cognitive difficulties, fatigue, moodiness and loss of muscular strength.
Men also may experience mild anemia, a decrease in body hair, increase in body fat, breast development, osteoporosis and infertility.
Testosterone replacement therapy can help with most of these symptoms, but there are side effects associated with hormone replacement, including acne, mild fluid retention, worsening of sleep apnea, smaller testicles and stimulation of the prostate, which can cause urination problems.
It also can decrease sperm count, which affects fertility, and can cause the prostate to grow. If a man has early prostate cancer, the hormone treatment could unintentionally speed up cancer growth.
Not all medical experts are convinced on the idea of a "male menopause," but studies have shown that lower testosterone can affect a man's overall health.
Though there is no way to prevent the natural decline of testosterone, experts say a healthy lifestyle including a good diet, exercise and weight management as well avoiding excessive alcohol and drug consumption, can help maintain normal hormone function.
Previous research has shown that men with lower testosterone levels are more likely to be obese and develop diabetes and non-alcoholic fatty liver disease. But a new study offers hope that testosterone replacement therapy can help.
In the two-year study, the therapy not only reduced the symptoms of hypogonadism, but also decreased the prevalence of non-alcoholic fatty liver disease among these men. The data was just presented at the 23rd European Congress of Endocrinology.
Dr. Kristina Groti Antonic, of Slovenia, explained that "improvement of non-alcoholic fatty liver disease grade was a result of improved insulin resistance, reduction in body mass index and body weight, along with changes in body composition."
She explained that testosterone increases lean body mass and also has anti-inflammatory properties which helped reduced the chronic inflammation in the liver.
Lower testosterone levels may also help explain men's increased risk of severe COVID-19, researchers from Washington University say.
The higher rates of severe COVID-19 among men previously was thought to be the result of higher testosterone levels, but the latest data suggests that lower levels of the sex hormone may be to blame instead.
While the researchers couldn't make a direct cause-effect correlation, they found lower levels of testosterone was predictive of more severe disease.
The researchers noted that severe COVID-19 also was associated with older age, obesity and diabetes which are also linked to lower testosterone levels.
"During the pandemic, there has been a prevailing notion that testosterone is bad," senior author Dr. Abhinav Diwan said. "But we found the opposite in men. If a man had low testosterone when he first came to the hospital, his risk of having severe COVID-19 — meaning his risk of requiring intensive care or dying — was much higher compared with men who had more circulating testosterone. And if testosterone levels dropped further during hospitalization, the risk increased."
Men who are concerned about their testosterone levels are advised to talk to their doctors about getting tested. A simple blood test can measure the level of the hormone in the blood.