Many symptoms, many causes – why it’s important to closely examine low testosterone

Excessive sweating. Mood swings. Low libido. All these are widely known symptoms you may experience you as you grow older. Writer Thomas Meyer wonderfully described what living a «limp life» can look like. In women, this life phase is called menopause – and in men? Does andropause, the male equivalent of female menopause, exist? I called up Dr. Günter Stalla, internist, endocrinologist, andrologist and chairman of the Deutsche Gesellschaft für Endokrinologie (German Society of Endocrinology) to get to the bottom of it. His reply: «No, ‘andropause’ isn’t an established term in endocrinology and andrology. What happens to men during this time isn’t comparable to menopause.»

The end of hormones – permanent and clear-cut in women, slow and perpetual in men

Here’s the thing: the period known as menopause first rears its head with falling hormone levels in what’s called pre- and perimenopause, while menopause itself is marked by a woman’s final menstrual period. «It's a brief event in the 50 to 52 age group where there’s a complete stop in hormone production.» How about in men? Although production of the hormone testosterone does sink continuously from the age of 40 by about one per cent each year, it’s a gradual process. And, unlike in females, it never culminates in a total stop; men have the ability to father children until they die. Postmenopausal women, on the other hand, are infertile.

«What’s more, it’s not possible to make the blanket statement that all men of a certain age have too low a testosterone level,» says Stalla. «There are older men who have perfectly normal values. They’re biologically healthy, exercise and have no underlying medical conditions. And then there’s a second group in which testosterone goes down. The cause is either functional or organic.» All this to say, it’s necessary to make this distinction in testosterone deficiency or «hypogonadism».

First come the pounds, then the testosterone deficiency

In so-called primary hypogonadism, the cause lies in the testicles and is usually organic, i.e. congenital. However, drugs or diseases or radiation can also damage the testicles. According to the «European Male Ageing Study» (EMAS), the primary form of hypogonadism affects two per cent of men, while the second form, secondary hypogonadism, affects 11.8 per cent. In the latter, the hormonal drop has to do with the control centre in the brain – specifically, the pituitary gland or hypothalamus. Both can be permanently disrupted by craniocerebral trauma, tumours or genetic disposition.

Or – listen up, guys – by malnutrition, obesity, type 2 diabetes and medication (which includes alcohol). According to Stalla, obesity is the most common cause of functional testosterone deficiency. The good news is that men with this form of hypogonadism can take the reins by making lifestyle changes.

If you treat causes such as abdominal fat or poor diet, testosterone levels increase and symptoms improve or disappear completely.

«If you eat healthy, have a hobby that provides a psychological balance, if you get enough sleep and are physically active, you reduce quite a bit of what can lead to a functional disorder like hypogonadism,» says andrologist Stalla. That way, there’s no need for hormone replacement, which is commonplace in the anti-ageing business. Here, too, it’s important not to generalise. «Of course, if you as a physician find symptoms that point to hypogonadism, you can give the patient testosterone for three months to see if your patient is subjectively or objectively better off afterwards. But before you do that, you need to identify the root cause!» On the flip side, hormone administration over more than six months reduces the natural control function in the brain in the long term. «With that, you get into territory of a therapy that’s detrimental to the patient. As far as I’m concerned, that’s not medicine – it’s a business.»

Testosterone deficiency? Why you should go to the doctor

It’s important to know that the multitude of symptoms and possible causes can’t be lumped under one umbrella – especially not under the questionable designation of «andropause» or «male menopause», as might be used by a business in the anti-ageing industry that expert Stalla is so critical of. Low testosterone levels should always raise alarm bells with your doctor, anyway. Why? Because they can indicate an underlying disease that’s gone undiagnosed, such as diabetes, cardiovascular disease or kidney disease. This needs to be properly examined.

A drop in hormones can manifest in many different symptoms, for example, in sexual symptoms such as loss of libido, weaker erections and fewer morning erections, psychological symptoms such as depressed mood and concentration problems as well as somatic symptoms such as hot flashes, osteoporosis, weight gain and daytime sleepiness. Erectile dysfunction, on the other hand, is rarely related to testosterone deficiency. Here, too, the changes men experience are different from those women do. Women will suffer from a catalogue of typical symptoms; according to the article «Klimakterium virile – Mythos oder Realität?» (Climacterium virile – myth or fact?) by the «Swiss Medical Forum» the official continuing education organ of the FMH Swiss Medical Association, typical symptoms are actually quite atypical in men. The article states that the ageing process, which can – but need not – be accompanied by a significant testosterone deficiency, is very individual. So, to any men reading this, be sure to consult a specialist to find out the cause of your symptoms.

What can men do to prevent old-age complaints?

Biting into a slice of pizza instead of a lettuce leaf with a guilty conscience? Urologist, andrologist and author of «Der beste Sex deines Lebens» (English: The best sex of your life) Dr. Frank Sommer has a few good tips for all men. He’s president of the Deutsche Gesellschaft für Mann und Gesundheit (German men’s health association) as well as a professor of men’s health in Hamburg. The marks he gives us aren’t great: «We’re becoming increasingly unfit. If they live a bad lifestyle, many men will start experiencing a drop in hormones starting at age 30.» His main piece of advice for his patients: take more responsibility for yourself and your body.

After all, it’s really not that hard. Exercise regularly, consume as few toxins – i.e. alcohol, drugs and nicotine – as possible, and eat as healthy a diet as possible. And take care of your mental health. Do what makes you happy and fulfils you, and avoid or reduce stress. «This has a positive effect on your hormones,» Sommer says.

If you’re now thinking you’ll have to go from couch potato to marathon ace (and therefore end up staying seated), don’t worry: in this case, less is still more. Here’s how Sommer puts it: «Both exercising your muscles as well as continuous movement that stimulates the cardiovascular system support healthy ageing.» This can be in the form of long walks, jogging, swimming or cycling. But it already helps if you change just the small things. For instance, use the stairs instead of the elevator and opt to walk to nearby places instead of driving. Even exercising your muscles sounds much less daunting if you use the 3x3x3 method. Namely, complete:

• 3 exercises for muscle strength
• 3 times a week
• for 3 minutes.

Anyone can manage that – and it alone can make a big difference.