When a woman reaches her late forties or early fifties, she undergoes bodily changes associated with reduction of female sex hormones and the ending of her periods. These changes are often associated with symptoms such as hot flashes, mood swings and/or depression, vaginal dryness, atrophic changes in the vagina and skin, reduced sexual desire, and an accelerated bone loss leading to osteoporosis. These changes in a woman are called the female menopause. The symptoms and signs associated with this condition can generally be corrected with the judicious use of natural hormonal replacement therapy. Unfortunately, most gynecologists today do not use natural female hormones for replacement, but rather synthetic hormones or hormones that do not entirely match the female hormones that are being replaced.

The concept of a male andropause has been more controversial than that of the female menopause, with many arguing that it doesn’t exist. Part of the reason for the controversy is that, in contrast to women, men do not have a clear-cut external signpost, namely the cessation of menstruation. Nevertheless, even though women do have this clear-cut demarcation, the changes that take place in their bodies associated with the stopping of menstruation, occur gradually over months or even years. This period, during which a woman may experience irregular menstrual periods, hot flashes, mood swings and other bodily changes, is often called the peri-menopausal period.

A man often begins to experience changes in his body somewhere between ages 40 and 55. These bodily changes may be accompanied by changes in attitudes and moods. During this time a man frequently begins to question his values, accomplishments and the direction of his life. The entire gestalt of these changes has led to the notion of the mid-life crisis. In this series, I’ll not focus on all aspects of these changes, but rather on the physical bodily changes that has been termed the male menopause or andropause. We’ll look at what occurs and what can be done to slow down these inevitable changes of aging.

The physical changes that occur with andropause may be divided into: (1) urinary and sexual changes and (2) more generalized changes. The urinary-sexual changes, which may occur in any combination and in varying degrees, include: (1) reduced sexual desire or libido, (2) reduced sexual potency or difficulty developing or maintaining erections, (3) ejaculatory problems, (4) reduced fertility, and (5) urinary problems, such as increased urinary frequency-especially at night, a weak urinary stream, hesitancy during urination, difficulty starting urination, and urinary incontinence. All of these changes, as I shall show, may be due, at least in part, to a gradual failure of the testes’ production of testosterone, the male sex hormone. This would be analogous to the changes seen in a woman, who at the time of menopause, has a reduction in the female sex hormones, estrogen and progesterone.

Metabolic Effects of Testosterone
The importance of testosterone to sexual and urinary functioning seems intuitively evident. What is not so apparent is the role of testosterone in more generalized functions. Testosterone is an anabolic hormone, which means it helps to build protein tissue, including muscles, bones and connective tissue. This gives it a role in preventing and treating osteoporosis in both men and women. Testosterone is helpful in building muscle mass, as every weight lifter knows. Unfortunately, many weight lifters and athletes misuse the synthetic analogues of testosterone, called anabolic steroids, by taking excessive doses, which can result in serious adverse consequences. A deficiency of testosterone may bring about a weakness in muscles and bones. This tissue deficiency of testosterone is characteristic of the andropause.