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Andropause — also colloquially known as male menopause — is said to be the result of a gradual drop in testosterone, which is an androgen. The medical community is currently debating whether or not men really do go through a well-defined menopause. The condition “andropause” is currently not recognized by the World Health Organization. When andropause occurs, it is considered to be a deficiency state in which the hormone testosterone goes below the normal range for an aging male.

Andropause is caused by the reduction of hormones testosterone and dehydroepiandrosterone in middle-aged men. Testosterone assists the male body in building protein and it is crucial for normal sexual drive and stamina. Testosterone also contributes to several metabolic functions including bone formation, and liver function. Andropause is also associated with a decrease in Leydig cells. A steady decline in testosterone levels with age (in both men and women) is well documented.
External factors that can cause testosterone levels to fall include certain forms of medication, poor diet, excessive alcohol consumption, illness, lack of sleep, lack of sex, stress, or surgery. It can also be a symptom of neuroendocrine dysfunction after a mild traumatic brain injury.

Internal causes
Andropause is preceded by a condition called Hypogonadotropic hypogonadism. A downturn in the circulation of testosterone can 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 is 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.

Eventually, testosterone levels drop to such low levels, the hypothalamus and pituitary kick in and produce high levels of GnRH and LH to compensate. This triggers the production of testosterone, which will generally work for a while, but then will fall again. That’s when men enter andropause. They have a low testosterone and a high LH and GnRH, whereas before they had a low testosterone as well as low LH and GnRH.

This shift in hormonal patterns occurs in all men at some point. The female version, a similar hormonal shift that occurs in women happens in a more narrow age grouping, from early forties to late fifties.

Testosterone levels decline gradually with age. Unlike females going through menopause, the decline in testosterone in men is gradual, and there is variation among individuals. Upon reaching 80 years of age, the rate of testosterone secretion has decreased about 50% for men.

The American Association of Clinical Endocrinologists defines hypogonadism as a testosterone level that is below the lower limit of normal for young adult control subjects.

Researchers conclude there is no black-and-white cutoff for “low” or “suboptimal” testosterone. Different symptoms show up at different testosterone thresholds: Muscle mass and strength do not decline until testosterone drops quite low (significantly below normal levels) whereas libido may dampen with relatively small decreases in the hormone. According to Joel Finkelstein, associate director of the Bone Density Center at Massachusetts General Hospital in Boston, men’s functioning is not impaired solely by a loss of testosterone, but by a loss of estrogen as well.

Agreement on the threshold of testosterone values below which a man would be considered hypogonadal has not been reached. Testosterone can be measured as “free” (that is, bioavailable and unbound) or, more commonly, “total” (including the percentage that is chemically bound and unavailable). In the United States, male total testosterone levels below 300 ng/dl from a morning serum sample (most accurate measurement) are generally considered low. To confirm the low levels of testosterone, doctors recommend repeating the measurement of morning total testosterone.
Proponents of andropause as a distinct condition claim that it is a biological change experienced by men during mid-life, and often compare it to female menopause. Menopause, however, is a complete cessation of reproductive ability caused by the shutting down of the female reproductive system. Andropause is a decline in the male hormone testosterone. This drop in testosterone levels is considered to lead to in some cases erectile dysfunction, diabetes, loss of energy and concentration, depression, and mood swings. While andropause does not cause a man’s reproductive system to stop working altogether, many experience symptoms of it impotence.

Much of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond, a lay person. According to Diamond’s view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, generally between the ages of 40 and 55, though it can occur as early as 35 or as late as 65. The term “male menopause” may be a misnomer, as unlike women, men’s reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives (at age 90 or older[16]). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.

The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.

Many clinicians believe that andropause is not a valid concept. Men can continue to reproduce into old age; their reproductive systems do not stop working completely in midlife, and therefore they do not exhibit the sudden and dramatic drops in hormone levels characteristic of women going through menopause.

Other clinicians have the opinion that andropause is simply synonymous with hypogonadism or unusually low testosterone levels. There is opposition to the concept of andropause in Europe as well as the U.S.

Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition. For example, people who are overweight may be misguided into treating a new illness rather than addressing the lifestyle that led to their being overweight. Similarly, energy levels vary from person to person, and for people who are generally inactive, energy levels will automatically be lower overall.

While it is true that active and otherwise healthy men could in theory develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.

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