Men, andropause is not menopause (and watch out for male hypogonadism)

It often happens silently and there are men who only notice when their libido begins to show no signs of life.

Aging brings many changes for some men: from weight gain to lack of energy, to poor quality of sleep and lack of sexual appetite, many factors can be associated with all of this, but there is one that is inevitable – the decrease in testosterone levels.

The progressive loss of this sex hormone is a natural process in the male organism and gives rise to what is called “andropause”, a controversial term within the medical profession, in particular because of the constant comparison with menopause. Ana Meirinha, specialist in urology at the Lusíadas Lisboa Hospital, does not hesitate to say that these are two clearly different concepts.

“Although there is a decline in testosterone with age, which is physiological, having testosterone below established physiological levels is a disease,” male hypogonadism, the doctor warns. According to the International Society for Sexual Health, the standard is 300 ng/dL (nanograms per deciliter of blood) as the minimum reference value.

“Andropause is what we call ‘androgen deficiency syndrome’. According to studies, there is a decrease of about 1% in testosterone production after the age of 30,” explains psychologist and sexologist Fernando Mesquita.

It’s not the same as menopause

According to a study published in western journal of medicine. “The term ‘male menopause’ is inappropriate because it suggests a sudden drop in sex hormones, as occurs in perimenopausal women.”

Of the same opinion is the UK National Health Servicewho says “this label is misleading because it suggests that the symptoms are the result of a sudden drop in testosterone in midlife, similar to what happens in female menopause – and that’s not true “.

” At men’s, [a hormona sexual] decreases but is not supposed to be abolished”, as it happens in menopause, explains Ana Meirinha, who continues: “Andropause does not imply the cessation of androgen production”.

And this gradual decline in the sex hormone is one of the big differences between andropause and menopausewhose progesterone and estrogen levels drop.

Signals the body gives when testosterone begins to decline

Symptoms of andropause are numerous and include, for example, decreased strength, reduced muscle mass, loss of bone density and accumulation of abdominal fat.

Since these symptoms are often silent, easily confused, or even the result of other clinical conditions, they are sometimes underestimated. Men “may think it’s a natural aging process and don’t ask for help,” Mesquita points out, adding that many men don’t realize something is wrong when they start. experiencing difficulty getting an erection or experiencing changes in sexual desire, the so-called libido. “At 45, they feel they still have a lot of life ahead of them.”

Andropause can also lead to reduced testicle size, breast swelling, and hair loss. In some cases, as Fernando Mesquita says, it can also affect sleep quality and cause mood swings. The age at which these symptoms appear depends from man to man, his state of health and of course his testosterone level.

According to information from Professor of Dr. Fernando Fonseca Hospital, diabetes, obesity and metabolic diseases – such as “hypercholesterolemia, fatty liver and osteoporosis” – may be risk factors for testosterone levels to drop sooner. “Smoking and frequent consumption of alcoholic beverages are still common causes.”

Remember: ask for help

As for treatments, Ana Meirinha specifies that this must “always be discussed with the patient”. But sometimes lifestyle changes are enough to control some of the symptoms and effects of low testosterone.

Since there is a risk of resorting to alternative treatments and whose impact is not always measurable, the doctor indicates that the man must seek help as soon as he feels that something is wrong. And, as a rule, the youngest are the first to do so.

“Younger men are quicker to look for solutions, in their minds it’s supposed to be like that in a few years but not now. Even at 40 and 50, they know it’s not supposed to,” he says, revealing that several types of patients come to him: the very knowledgeable, the uninformed and the “white papers”. He adds that it is sometimes difficult to fight against the preconceived ideas that many take after researching online.

Replacement therapy is the method used for cases where there is, in fact, a drop in testosterone levels, although Ana Meirinha points out that each case is different but that men should not ignore what is happening at all. pass.

“If you are unhappy because you have a low libido, if you are more irritable and less dynamic, if you express this, you need treatment. As a general rule, everyone wants to seek treatment, because the decrease in testosterone increases the risk of cardiovascular disease”, underlines the doctor.

The mistake

Although it is a natural condition of human development and aging, little or nothing is said about andropause and Fernando Mesquita is quick to say that it can happen due to man himself and his possible tendency not to show his weaknesses – who are but who in their eyes may be.

“We don’t talk about it because the symptoms are considered normal and a lot of men are reluctant to seek medical and therapeutic help, they devalue it, they feel it’s a passing phase. Or finally they have pain. resistance because it could be a confrontation because they feel less like a man,” he explains.

Ana Meirinha says loss of libido and difficulty getting and maintaining an erection aren’t the only reasons men seek counseling, but she says erectile dysfunction is a “multifactorial” condition and not just the result of ‘a fall. testosterone levels. “A lot of times men come for a consultation for dysfunctions and it’s part of the study to measure testosterone,” he explains, explaining that “lack of testosterone decreases erectile capacity and libido, but as it is such a multifactorial pathology in its genesis, it is very difficult to say that it is caused solely by the drop in testosterone.

“Men think they’re turning 80 and they’re supposed to feel that way, many live with that stigma,” laments the doctor.

There is more sexuality beyond andropause

Problems with sexual function are, for many men, a red flag. But these difficulties should not be taken as a sentence – and that regardless of the age of the man or the partner.

When asked if andropause can be the springboard for men and couples to seek other forms of eroticism than penetrative sex – whether vaginal or anal – sexologist Fernando Mesquita does not hesitate to say “that shouldn’t be the reason”. .

“We should try to explore our sexuality even if we don’t have problems, but in those cases it’s important that the couple try to manage some difficulties,” he acknowledges, going on to say that it’s not isn’t always easy, especially when sex is the result of a relationship, of a norm, of something that has to follow a norm.

“If we have a specific scenario where there has to be desire and arousal in sex, where you have to hold on for who knows how long, give orgasm, if we have that scenario, face some difficulty, we start to avoid sex or feel like it’s over,” he says, explaining that couples should look for other ways to give and feel pleasure.

Fernando Mesquita considers that couples who have always explored other forms of eroticism and sexuality end up having an easier time dealing with this type of difficulty, while those who have never explored beyond coitus can more easily being held hostage by “pre-sex anxiety”. , which alone will make the act difficult, in a kind of vicious circle.

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