Is male menopause myth or reality? When men reach their late forties to early fifties, some may experience a reduction in libido, erectile dysfunction, weight gain, fatigue, depression, and other emotional symptoms which bear similarities to female menopause.

Andropause, or male menopause, is a name that has been given, in some parts of the English-speaking world, to a set of effects that appears in some aging men, and which have some superficial similarities to menopause effects in women.

Andropause is currently not recognized by the World Health Organization (WHO) and its ICD-10 medical classification.
Hypogonadism when it occurs in men is however considered to be a deficiency state in which the hormone testosterone goes below the normal range for an aging male.

This set of effects may be related to the slow but steady reduction of the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men, and the consequences of that reduction. It is also associated with a decrease in Leydig cells.

What Causes It?
There are both external and internal factors that can cause testosterone levels to fall. External factors include certain forms of medication, poor diet, and excessive alcohol consumption, and illness, lack of sleep, lack of sex, stress or surgery.

Internally, Andropause is preceded by a condition called Hypogonadotropic Hypogonadism. A downturn in the circulation of testosterone should cause the hypothalamus and pituitary gland to trigger a release of brain hormones that stimulate the testicles to ramp up production of testosterone.

Although, as men age, despite low testosterone, the levels of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) will not rise. The luteinizing hormone, gonadotropic releasing hormone, and testosterone all are dropping below what’s considered normal. Low GnRH, low LH, low testosterone indicate the syndrome of Hypogonadotropic Hypogonadism, and it is a downward trend that takes men closer to Andropause. This phenomenon typically begins in the early forties.

It is a condition that happens without warning as when the heart of a seemingly healthy man stops beating. For men it can begin as a slow, dawning treachery. Beer and pizza that once burned away quickly clings to the belly. Aches and pains that used to vanish overnight linger a few days, than a few weeks, then forever. The eyes start to blur. The ears muffle. The legs lose their springs, cells mutuate and cancers activate. Most distressing for many men, is that it changes personality. Once an eager Labrador pup ready to jump up and play, more and more it resembles an old dog that would rather nap then fetch.     
       
The coverage of male menopause in popular magazines took a different route from that taken in medical journals in the second half of the twentieth century. Initially, however, the two literatures corresponded, with the lay press taking its cues from the professional literature. In 1935, Time reported news of the discovery of testosterone and its imminent synthesis. Although the article made no specific mention of a change of life for men, it clearly expected its readers to know about the rejuvenation efforts of the previous decade. Monkey glands may have been ineffective, but synthetic testosterone promised to ‘revitalize old men’.

It was this testosterone deficiency that would be taken up by physicians in their reconceptualization of male menopause as Andropause in the years to come. Impotence, of course, was renamed erectile dysfunction and once Viagra came on to the market in 1998, the condition was less often associated with low testosterone and the ambiguous diagnosis of male menopause. Rather, as sociologist Jennifer Fishman has noted, the ‘organization’ of impotence limited the scope of the disorder to the penile organ itself. This development helped to spur the revival of testosterone as a therapy for male menopause. Recall that one of the reasons testosterone had dropped out of medical favor in the late 1950s was its ineffectiveness in treating impotence. Once this condition was dropped from the list of complaints, it removed that barrier to prescribing testosterone for climacteric men. And any barrier that might have been presented by the hassle of frequent injections was also removed when the Food and Drug Administration (FDA) approved a testosterone patch in 1995 and a testosterone gel in 2000.

These technological developments in hormone delivery systems, combined with the subtraction of the impotence problem, played a role in the medical profession’s renewed interest in male menopause, or Andropause, as it had been renamed. In the late 1990s, more articles began to appear in medical journals on male menopause. The titles of these articles echoed those of the 1950s: The Male Menopause: Fact or Fancy?; The Andropause: Fact or Fiction?; The Male Menopause: Does It Exist? Although it would be hard to identify a consensus in this literature, one point of concurrence was that there was some sort of age-associated decrease in testosterone. If this notion—which some like to call ADAM (androgen deficiency in ageing men)—was to gain widespread medical currency, it would describe a long-term disorder. Readers of popular periodicals had long been exposed to the notion that mid-life misery should be considered a medical issue.

The history of male menopause raises interesting questions. There is also the question of cancer risk. Doctors fear that testosterone could inflame undetected tumors. Testosterone is believed to accelerate the growth rate of known prostate cancers, and suppressing the hormone is a standard part of treating advanced cases of the disease. Given that prostate cancer is a leading cause of death among aging men, the worry is that boosting T levels could be like dropping matches in a dry forest. 

Currently, millions of American women take hormones to reduce the negative effects of low estrogen levels during and after menopause. A similar syndrome in men has been recognized in Andropause. The difference in the way men and women experience this change is that it is a much slower process in men so it is often not as obvious. In men, mid-life hormone changes usually begin without notice, especially after the age of forty. If we take the case of the U.S. market, there is a T prescription boom—2.9m prescriptions in year 2007 v/s 7.5m prescriptions in year 2013. The sales of T medicine in 2013 were $2.4bn and are projected to $3.8bn by 2018. On the other end marketing campaigns by pharmaceutical players are on the rise in a bi way in the U.S. market. 

The magic potion is being sold in the form of Viagra, Cialis, Levitra and other ED drugs in modern times. Calling the shots, Testosterone can be administered through topical gels, injections, nasal sprays and patches. The feeling of insecurity that comes with aging will push drug sales across the globe, which is evident when we compare the figures in the U.S. to other parts of the world. However, in the coming year the treatment of low testosterone  will hit like a storm in the emerging economies as income levels continue to increase and general health reforms continue. The current generation will spend its money and fight for the cause as compared to earlier generations.