Male Menopause – is there such a thing?

by Diana Arundell university qualified Naturopath and Nutritionist 

Menopause gets plenty of attention but what about hormonal decline with age in men? It’s extremely common for men to ‘not feel themselves’, experience low mood, lower libido and general mojo decline as they move through their 40’s, 50’s and beyond. It’s estimated that 50% of men over 60 years of age have a decline in testosterone and it’s suggested that testosterone levels may start to significantly decline in men from the age of 40. Androgen or male hormone deficiency is referred to as ‘andropause’ or colloquially ‘male menopause’. Androgens are produced in the adrenal glands as well as the testes and the cause of age-related decline in testosterone in males is considered multifactorial. 

There are a number of things that can contribute to a decline in testosterone levels in ageing men such as diet, lifestyle, medication, illness and stress. Some of the signs of low testosterone levels in men can be difficult to diagnose as they are also potential signs of general ageing. These include reduced libido, erectile dysfunction, night sweats, hot flushes, reduced feeling of general well-being, sleep disturbance, decreased muscle mass and strength, decreased bone mass and abdominal obesity. Men may also experience psychological symptoms such as anxiety or depression, mood swings and lack of motivation. As previously mentioned, these symptoms are not uncommon in the general ageing process.

As low testosterone signs and symptoms may be non-specific and overlap with other health issues such as thyroid and/or adrenal dysfunction, nutritional deficiencies, blood sugar and insulin dysregulation, pathology tests to determine the full picture can be useful and it’s always important to test for both free and bound testosterone in the blood. Some naturopathic practitioners prefer to use saliva testing to establish hormone levels as saliva testing reflects the non-protein bound hormones (free) or those that are more readily available for cellular uptake. Therefore the measurement of ‘free’ hormones rather than protein bound hormones may better reflect a person’s hormone related symptoms.

Foundations of good health include nutrition, water intake, sleep, exercise and the ability to de-stress and create happiness in life. Nutrition is primary for optimal health and well-being including good hormone production. For the ageing male, the best nutritional approach includes predominantly fresh, whole foods based on an abundance of fresh vegetables, fruit and adequate protein. Protein is essential to reduce muscle wasting, immunity and hormone production as well as providing slow burning fuel for the metabolic fire for energy. Good sources of protein include fish, chicken, turkey, eggs, lean red meat, tofu, chickpeas, lentils.  Essential fatty acids and fat soluble vitamins that can be found in foods such as such as nuts, seeds, nut butters, fish, avocado, olives and olive oil, are important for steroid hormone synthesis and cardiovascular health. Omnivores generally have higher free testosterone levels in the blood than vegetarians. Morbid obesity will often be accompanied by a decrease in free testosterone.  

Further to the above suggested dietary inclusions, there are also things to avoid such as high consumption of alcohol and caffeine. Excess consumption of alcohol and caffeine may affect the absorption of vitamins and minerals leading to suboptimal nutrition and consequently reduced testosterone levels. Intoxication with alcohol may lower testosterone for up to 16 hours after consumption and for regular heavy drinkers this may lead to ongoing lower testosterone level issues. 

Medications and polypharmacy (taking several medications) such as blood pressure medication, hypnotics, anti depressants, antifungal medications and steroidal medications may reduce testosterone levels in older males. There is a time and place for these medications and at times they can be life saving, however for chronic disease it’s always beneficial to also address the underlying cause of ill health. Often addressing diet, lifestyle and mental/emotional health may reduce the need for some medications and may lead to lower dosage requirements which can in turn lead to reduced side effects. Never stop medication without discussing a well supported reduction regime with your medical practitioner. 

Both ongoing physical and psychological stress in men can also reduce testosterone levels as can some chronic diseases such as rheumatoid arthritis and liver or kidney disease. Maintaining a healthy body weight is important to support healthy hormone production. Excess body fat particularly around the abdomen in males can increase estrogen production and elevated estrogen in males can reduce testosterone production via a negative feedback loop. There may also be a relationship between insulin resistance and lower testosterone levels in obese males.  Regular exercise is crucial in supporting health body weight as well as helping reduce stress hormones and improve cardiovascular health.

If low testosterone levels are confirmed via hormone testing, testosterone replacement therapy (TRT) may be suggested and this treatment may be offered in the form of pharmaceutical or bioidentical hormone replacement therapy. Bioidentical hormone replacement may be considered a better option due to the more individualised approach however both forms of hormone replacement are synthetic and carry risks of side effects and so the risks should always be considered alongside the benefits. A naturopathic approach focuses more on supporting the body back into balance and the best possible state of health which in turn results in a healthier balance of hormone levels. Inevitably this approach requires the individual to be willing to address diet and lifestyle issues and comes with the benefit of being a longer term solution as well as improving other general health and wellness parameters. 

The naturopathic approach to improve testosterone levels in men should always include a treatment plan addressing physical, mental and emotional well-being. A comprehensive review of diet and lifestyle as well as correcting any nutrient deficiencies, implementing stress management strategies and the use of nutritional and herbal medicine can be very effective as part of a holistic approach. 

Diana Arundell is a university-qualified naturopath and consults from her Avoca Naturopath clinic. She has a special interest in fertility and pregnancy health, digestive health, immune function and family wellness programs. She was a nutrition lecturer at Macquarie University for 10 years, and is an accredited Journey Practitioner. For further information please contact Diana Arundell at Avoca Naturopath on 0410 465 900.