The attention of the medical community had long been fixed on the precipitous drop in hormone levels that accompany menopause in female patients. This sudden and sharp decline in hormone levels is accompanied by an eruption of symptoms, including: hot flashes, night sweats, depression, mood swings, and weight gain. These female patients are often desperate for symptom resolution and can find relief in bioidentical hormone replacement therapy (BHRT). However, this focus has long overshadowed the hormonal changes that occur in men as they grow older. This decline in testosterone levels is often referred to as andropause, and occurs at a much slower and steadier rate than the sharp decline that is seen in females.

It is estimated by urologists that testosterone loss occurs at a rate of 1 to 3% per year, after a peak in the early to mid 30s. This decline is accompanied by the steady emergency of symptoms as the man grows older. This is a more insidious mechanism than what is seen in female patients. The testosterone-producing cells in the testicles, called Leydig cells, begin to function less and produce less testosterone as age progresses. This is unavoidable and is a natural consequence of aging. Other factors contribute to the decline in male hormone production as well: if the man is overweight, or gains weight due to decreased testosterone levels, he is producing more adipose (fat) tissue. This fat houses an enzyme called aromatase, which is responsible for metabolism of testosterone to estradiol, an estrogen. Therefore, the more fat a man has on his body, the more of his testosterone that will convert to estradiol. Men need estradiol, just like women… however, they just need a smaller amount. Estradiol levels in men that are too high or too low are a marker for cardiovascular disease. In today’s increasingly unhealthy society, other comorbidities are present as well: diabetes, hypertension and obesity are all tied to lower testosterone production. 

This lower testosterone production results in symptoms for men, including: increased weight gain around the midsection, loss of libido, erectile dysfunction, loss of muscle mass, loss of endurance, mood disruptions, depression, anxiety, feeling dissatisfied, lethargy, and fear of failure. Look at that list again. Look at all of the mental and cognitive effects that low testosterone levels have. Testosterone has a profound effect on multiple organ systems in the body, and on overall quality of life. It is important to give equal attention to male patients regarding their testosterone levels as they get older.