Men’s Health: Addressing the “M Word” (Manopause)

Exploring the Unspoken: Male Menopause and the Taboo Around It

By Andrea Samuels, Jerusalem Post, May 12, 2024

So, what about guys? 

When I started this column, men and women asked me about male menopause – or, if you will, manopause. Recently, I sought out a couple of menfolk to find out a bit more. 

Like most, I knew little about the subject, as seen from across the sexual divide. Small wonder. For one thing, unlike its female counterpart, male menopause isn’t openly discussed. Support groups for men who are experiencing manopause, such as the women’s Facebook menopause support group with more than 35,000 members to which I belong, are thin on the ground.

A computer search reveals one such group for males with only a smattering of members. 

Some even deny its existence altogether, instead blaming the aging process for the changes that men experience at around the same age as menopausal women – which is to say, the late 40s to early 50s.

“The term ‘menopause’ has evolved to mean a brief period during which the ovaries complete their evolution and cease to ovulate,” Dr. Stanley G. Korenman, an associate dean and professor of medicine, writes in the Western Journal of Medicine (WJM). 

Men have “no specific analog to this narrowly defined menopause,” Korenman believes.

Medical directors Duncan C. Gould and Richard Petty strike a similar note in the WJM: “The term ‘male menopause’ is inappropriate because it suggests a sudden drop in sex hormones such as occurs in women in the perimenopausal state.”

But they go on to say that “because of the similarity of most of the symptoms between men and women, the term [male] ‘menopause’ gained popularity and has, unfortunately, stuck.”

As a way of getting around this conundrum, Korenman coined a new term. “I dislike the term ‘male menopause’ because of its reference to cyclicity, and I have adopted ‘manopause’ as an umbrella term to describe age-related alterations whose exact nature is still to be determined,” he explains.

So what is male menopause?

What, then, is manopause, and what changes can a man expect to experience when he reaches that stage of his life? What, as the cool kids say in med school, are the diagnostic criteria?

Research scientist Dr. Joshua Smith answers this in his article on the Medichecks website: “As men age, their testosterone levels tend to decline – this is a normal process. It’s sometimes referred to as ‘menopause’ or ‘andropause,’ but these terms are misleading since it’s a very different process from menopause in women. In most men, male hormone levels decline very gradually and tend not to cause symptoms.” 

The drop in testosterone levels, known as hypogonadism, occurs when the testes don’t make enough of the hormone. It typically affects older men, particularly those who suffer from obesity or type 2 diabetes. 

Smith continues, “Some sources state that testosterone levels begin to drop in the 30s, with an average decline of 1% per year. Other data show that this decline may be slower than we think, starting in the early 20s, but almost plateauing by the late 30s.”

It’s hard to know whether symptoms that occur around this age are caused by hypogonadism or the aging process, which means that all too often, they are overlooked. Checking testosterone levels is a simple answer to the problem.

Keen to know more about the effects of manopause and how one deals with the symptoms, I spoke to 57-year-old Ben, and Jerry, who turned 60 last year (not their real names).

At the start of our conversation, Ben confirmed that he wasn’t sure whether his symptoms – which included graying hair and hair loss, disturbed sleep, hot flashes, irritability, and, most frustratingly, erectile dysfunction – were “menopausal or generic aging stuff.” 

Whatever the cause, they didn’t come on gradually as one might expect. Instead, he confirmed, they “all came at the same time,” making it plain to him that his “body was going through changes.”

“It’s an aging thing, but it definitely started all at the same time,” he said. “For example, if I cut my thumb, it would take longer to heal, and the healing is never as perfect or hermetic as it was prior to going through this process.”

Despite not consulting his doctor or taking anything for these symptoms, most have largely abated. However, his erectile dysfunction doesn’t seem to be improving: “I don’t know whether that will heal itself at all,” he lamented.

Unlike Ben, sexagenarian Jerry is convinced that the significant changes in his body are down to a version of male menopause, lamenting the fact that it’s a subject that is not widely discussed among guys. 

“Women talk about menopause a lot to other women, while men don’t talk about it at all,” he said, before adding sagely, “but they should.”

For him, the debatable issue of male and female menopause is clear. “It’s a reality for both sexes and is comparable because both occur at the same age.”

From around his late 40s, Jerry noticed a gradual drop in his energy levels, concentration, and sporting abilities. Memory loss was also becoming a problem. In short, his overall sense of well-being was suffering.

Not willing to succumb to his symptoms and simply wait for them to pass, he sought the advice of professionals. 

He now has regular blood tests to check his testosterone levels, which initially were found to be significantly low. Like many women suffering estrogenic loss, he has been prescribed HRT; small vials of testosterone that he injects periodically. He also takes zinc supplements and medicinal cannabis oil from time to time.

As a result, he confirmed that he feels and looks better, has more energy, and his sex drive has improved. His cognitive skills and concentration levels have also “demonstrably” increased.

Male menopause, manopause, or whatever name is given to it, is significant. The reluctance to discuss, or even recognize, these changes only makes it more difficult for men to seek help, which is a shame not just for them but for their partners as well.

It’s time to eliminate the stigma about male menopause by encouraging men to speak openly about what is, after all, just another part of life’s rich hormonal tapestry.  

More about testosterone

Testosterone is the main androgen hormone that determines the gender of a person. The default gender of humans is female, and even if the cells have a male genome with a pair of XY chromosomes, unless there is a high level of testosterone in the very early stages of differentiation, a baby will develop with female characteristics. There are several conditions, part of a category known as Disorders of Sex Development (DSD), in which a range of medical conditions can produce atypical chromosomal, gonadal, or anatomical sex development. 

Total T

Total T is shorthand for total testosterone, and it refers to the entire amount of testosterone hormone present in the bloodstream. The great bulk of testosterone in the body is attached to either albumin or sex hormone-binding globulin (SHBG). Only a small fraction of testosterone remains unbound and free to enter cells and exert its effects.

Bioavailable Testosterone

Bioavailable testosterone refers to the fraction of testosterone that is not bound to SHBG. It includes both free testosterone and the testosterone that is loosely bound to albumin, which can easily detach and become active. The levels of bioavailable testosterone are important because they represent how much testosterone is readily available for use by the body. It’s the form of the hormone that can actually enter cells and perform the functions testosterone is needed for, like supporting muscle growth, influencing mood, and maintaining energy levels.