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Overview

Low T, or Andropause, describes an emotional and physical change that many men experience as they age. Although the symptoms are generally related to aging, they are also associated with significant hormonal alterations. Andropause is a natural subtle decline in hormones that happens as men age. While medical professionals have known for a long time that the production of hormones by the testes slowly decreases as men age, interest has developed only recently in the clinical implications of andropause.

Andropause is also referred to as male menopause, male climacteric andropause, male andropause, late onset hypogonadism, or androgen decline in the aging male (ADAM). The term andropause may be considered somewhat inaccurate because the process is not universal and occurs subtly over time. In women, menopause occurs universally and usually happens dramatically, over a few years.

How Common is Low T in Men?:

Adam or andropause is a fairly common condition and the incidence of andropause (or hypogonadism) increases with age. The incidence from ages 40-49 is estimated between 2%-5%. From ages 50-59, the incidence is estimated between 6% and 40%. From ages 60-69, the incidence is estimated between 20%-45%. The incidence from ages 70-79 is estimated between 34% and 70%. The incidence of hypogonadism in men older than 80 is estimated at 91%. The spread of estimated ranges is quite large because different specialists use different ways to measure androgens and use different minimum levels to define andropause. The important thing is that if a patient feels there are reasons for concern, he should visit a doctor to learn more.

Can Low Testosterone Occur in Women?:

The medical community began researching and treating women with androgens (DHEA-S or testosterone) in the 1990’s.  There is more and more research attesting to its efficacy and safety.   However, there is little agreement about “normal” female testosterone levels. If a woman goes to a general physician and is told that her testosterone levels are “normal” all that means is that they are in a range of women who are not ill. It does not mean that the levels fall into a range that women need for optimal health and functioning.

However, the good news is that significant research continues in this area. Experts in the field continue to publish and have conferences dedicated to this area.  As a result, “normal levels” are being established although there is still a great deal of debate about the limits for each age. Each specialist in the field might have a slightly different range and may use different measurements for diagnosis including total testosterone, bioavailable testosterone, free androgen index or free testosterone.  Also, many specialists depend almost exclusively on symptoms, rather than blood levels.

A woman who would like her testosterone (and other hormone levels) assessed in order to better understand their effects on her sexual and overall health should find a specialist in the field of female sexuality and have them test her levels.  They should get a thorough history and place these results in context.  Finally, they must realize the complexity of female sexuality, and have a range of options for treatment/management available, including but not limited to hormonal treatment.  

We are very proud of our WOMEN’S CENTER staffed only by women, which provides a comprehensive, scientific, and warm atmosphere for women to address their sexual health.

  • Symptoms of Low T/Andropause
  • As we’ve said, andropause is rarely a sudden condition; it creeps up on you gradually. The main three symptoms are:

    • Decreased/low libido (interest in sex)
    • Erection issues
    • Decreased energy, muscle mass, and strength

    Other symptoms, all of which are significant and all of which may be positively affected by treatment, include:

    • Osteoporosis (which can lead to increased bone fractures and breaks, as well as a decrease in height) 
    • Mood Changes
    • Intellectual Focus and Mental Acuity Changes
    • Decreased Body Hair

    Decreased/Low Libido (Interest in Sex):

    A decreased libido can be quite devastating for a man and for his partner.  Popular culture projects that all men should want sex all the time. This is of course not true, even for men with good libidos.  But when a man’s libido is significantly reduced, his partner will often feel rejected. The partner may feel that you are finding her/him unattractive, that you are having affair, and may feel that this situation is very unusual.

    Libido can be diminished overall, or diminished in a particular situation.  A generalized decrease in libido usually means that a man loses interest in all kinds of sexual activity and in all contexts.  He may notice that he has less interest in masturbating.  He may be notice less an attractive woman/man that he sees or works with, compared to his baseline.  This of course means that he also has less interest in having relations with his partner.

    If a man has a generalized decrease in libido, it is important that he communicate this to his partner.  This will help her/him to feel less rejected personally, and to put it in a more medical context.

    In many cases, lack of interest in sex with your partner may be due both to an overall decrease in libido, combined with relationship issues. These issues must of course be addressed.

    Libido is shockingly physiological.  Almost all men will have a lower libido as their testosterone level decreases.  Almost all men will have a higher libido when their testosterone levels increase.

    Erection Issues:

    Erection issues are strongly correlated with decreased testosterone levels.

    The first thing that men may notice, are a decreased frequency and rigidity of their nocturnal or morning erections.  (Interestingly, this is often the first thing men notice when their testosterone levels are increased through treatment.)

    More importantly, men may find they are having true erectile dysfunction, with difficulty getting and maintaining an erection during relations.  This is of course quite upsetting to man and to his partner.  

    Erectile issues have many possible contributing factors, but a low testosterone is a significant one.  There are physiological changes in the penis with changes in testosterone levels.  Lower levels cause decreases in penile muscle, and increases in fat and fibrotic tissue.  Increasing testosterone levels causes an increase in penile muscle, and decreased in fat and fibrotic tissue.

    It may however take up to six months for men to notice an improvement in their erections after starting treatment for low testosterone.

    Decreased Energy/Muscle Mass/Strength

    As men get older, our energy levels, muscle mass, and overall strength decrease.  However, this process is accelerated by decreased testosterone, and partially reversed by increasing testosterone.  It is important to note that a 60 year old man is not going to be 18 again!  It is important to view “anti-aging” clinics with suspicion.  However, it true that the vast majority of men with low testosterone levels, who receive treatment will have a partial reversal of these symptoms.

    It is important to recognize that decrease strength and muscle mass, and conversely increased body fat, has significant negative implications for your overall health.  Most men gain much of their weight around their waist.  Some of this fat is simply subcutaneous (underneath the skin.)  However much of it surrounds internal organs.  This fat is particularly harmful, as not only does it contribute to the negative effects of other body fat, but is hormonally active in many negative ways.  We are increasingly learning how dangerous it is.

    There are strong correlations between muscle mass and strength and “fragility”.  Fragile men live shorter and have lower quality of lives.  Increased body fat correlates strongly with diabetes, blood pressure, cardiac disease, and osteoporosis.  

    Understand that these are symptom guidelines. Andropause affects different men in different ways and to different degrees. There are men who may get one or two of these symptoms, and may just notice the other symptoms occurring minimally or not at all.

    As you work your way through this website, take the AMS Questionnaire (SHOULD HAVE A LINK TO AMS QUESTIONNAIRE) if you’re concerned that you might have andropause. It’s a simple and effective way to detect this condition. Now, just because you have a few of these symptoms doesn’t necessarily mean you have andropause. It could be some other cause, so a blood test is the best way to make a diagnosis.