The truth about ‘manopause’ — and the ‘slow and insidious’ signs of low testosterone men overlook

It is not just women who face the harrowing hormonal effects of “the change.”

Andropause — commonly called “male menopause” or “manopause” — refers to age-related declines in testosterone levels.

And while women are known to have hot flashes, mood swings, dryness and a host of other symptoms during their middle-age transition, men are actually in for some uncomfortable side effects, too — and they might not even realize low testosterone is to blame.

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What are the symptoms of manopause?

An estimated five million men in the US struggle with low testosterone, with levels beginning to decline around 30. With age, those levels may continue to fall, with some men reporting up to a 50% reduction by age 70, compared to peak levels.

Some are hit over the head with side effects — but for others, the changes can be a bit sneakier, making it harder to know when to seek help.

“The signs and symptoms of low testosterone are subtle and can develop so slowly and insidiously that men often accept them as part of their natural aging process,” Dr. Pete Stahl, Head of Men’s Health at Hims, told The Post.

Some of the earliest symptoms are usually a dip in sex drive and persistent sense of fatigue, even after a full night’s sleep.

“Over time, they may experience loss of muscle mass and strength along with an increase in body fat, particularly around the midsection,” Stahl went on.

“Erectile dysfunction often occurs. Changes in mood, difficulty sleeping, irritability, brain fog, and poor concentration can follow, and the link between these symptoms and low testosterone is much less widely known and appreciated.”

Is manopause really equal to menopause?

“Similar to postmenopausal women, men with age-related testosterone deficiency experience profound changes in sexual, physical and metabolic health that make them feel very differently than when they were younger — be it fatigue, low libido, weight gain, or brain fog,” Stahl said.

“However, it’s not an exact equivalent. While most women will experience menopause at a similar age, declines in testosterone levels are more variable, happen much more gradually, and are not universal.

“Some men feel the effects as early as their 30s or 40s, while others maintain healthy levels well into old age.”

Stahl said that testosterone deficiency affects 30-40% of men by the time they hit their 40s or 50s with levels dropping more quickly in men with chronic illnesses or certain health conditions, especially obesity.

Long-term effects of manopause

In the short term, according to Stahl, these symptoms can seriously impact quality of life, from work to relationships to general self confidence.

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But they can also cause more serious issues down the line.

“In the long term, testosterone deficiency can have major implications for health and longevity,” he said.

“Low T has been associated with insulin resistance that can contribute to diabetes, loss of bone mineral density that can predispose to fractures, low red blood cell production that can lead to anemia, and high cholesterol that can lead to cardiovascular disease.

Despite these devastating consequences, the stigma around treatment options for low T keeps men from seeking help, and many doctors from effectively treating their patients.

Treatment options for manopause

Testosterone deficiency is typically treated by addressing the underlying cause of the deficiency, prescribing medication that boosts testosterone production, or treating a patient with testosterone replacement therapy (TRT).

“Taking testosterone can feel scary because [men] equate it with the dangers of anabolic steroid use that they’ve been warned about throughout their lives,” said the doc.

“For doctors, recently debunked studies warning about the cardiovascular risks of testosterone therapy still linger and often prevent them from treating affected patients.” 

Stahl said medications that drive natural testosterone production “are a great first-line therapy.”

“Unlike TRT, they do not impact fertility,” he explained.

Starting this week, Hims is offering low testosterone and personalized treatment plans that include compounded enclomiphene.

Next year, Hims will begin offering TRT in an oral form called Kyzatrex, which has been shown to restore testosterone levels in up to 96% of men with minimal side effects.

“The truth is that identifying and treating testosterone deficiency is an integral part of men’s healthcare. For a man with symptoms and low testosterone, restoring his levels to a healthy range can have a tremendous impact on his quality of life and healthspan,” he said.