Andropause, often called male menopause or aging male syndrome (AMS), refers to a complex set of physical and cognitive changes that can occur as a man's testosterone level drops somewhere between the ages of 35-65, but more typically between the ages of 40-55.¹

According to the FDA, up to 5 million American men may have low testosterone, but only 5 percent are being treated for the disorder.²

Andrew Dwyer, RN, FNP, senior clinical research coordinator at the Massachusetts General Hospital Reproductive Endocrine Unit, described ongoing discord among healthcare practitioners with regard to andropause.

"It's a similar discussion to female menopause - is andropause an illness or is it a normal part of aging?" he said. "Do you make a pathology out of aging in men?"

Sarah B. Freeman, PhD, RN, CS, FNP, clinical professor and director of the FNP and WHNP Programs at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, GA, also draws a parallel between andropause and female menopause.

"The constellation of symptoms in andropause are very much like they are for female menopause, but they happen a little later and not as dramatically in men," she said. "That's because men experience a drop in hormone level as opposed to a cessation."

No Laughing Matter

For men who are going through andropause, and for their partners as well, the effects of low testosterone levels are all too real.

"You see depression, irritability and a change in sleep patterns," said Dr. Freeman. "The man may sit down to watch TV and fall asleep in the evening, then have insomnia at night," she added. "We also see men with anxiety that they're not used to having, and often a decrease in sexual drive and sometimes erectile dysfunction."

Body changes secondary to low testosterone levels can have a significant impact on the man's quality of life. 

Muscle mass decreases and abdominal body fat increases. Many men also report a lower energy level, and complain that they're unable to lift as much weight as they used to, or that their endurance is diminished.

"Their ability to play sports and exercise is impacted by a very real difference in muscle strength secondary to low testosterone levels," Dr. Freeman said.

Cognitive changes common during andropause include impairments in short-term memory and spatial functioning.

"I call it the 'can't find your car keys phenomenon,'" said Dr. Freeman. "This isn't dementia, but these men often have cognitive changes similar to what we see in some women during menopause," she explained.

Personality changes often come along with andropause, Dwyer said.

"Usually the patients who come in have specific complaints, and irritability is a big one," he said. "Oftentimes, it's the partner or spouse who will say, 'you're not yourself, and you need to get checked out.'"

To that, Dwyer added: "Depression and anxiety are fairly common and are triggered by many different things in life. You need to rule out organic causes, such as low testosterone, early in the diagnostic process."

Testosterone Replacement

Testosterone replacement therapy (TRT) is the primary option for men with low testosterone levels, but there is little consensus among practitioners about when to initiate treatment.

"We used to tell men that some of these changes were absolutely normal parts of aging, but now we know that often these issues are associated with low testosterone levels," said Dr. Freeman.

"My general rule of thumb as a family nurse practitioner is that if the symptomatology is affecting the man's quality of life, that's when you start talking about testosterone replacement," she said.

"You have to balance the very real improvements that testosterone replacement can bring - improved sexual function, increased muscle strength, improved bone mineral density, a higher red blood cell count that prevents anemia, and a somewhat lesser improvement in cognitive and spatial function - with the negative side."