MANopause – is this even a thing??

You may wonder whether there is a male equivalent to the female menopause, and, “yes fellas, there is!” The technical name for it is andropause, but also commonly referred to as manopause, male menopause and sometimes humorously linked to the ‘midlife crisis’ and ‘grumpy old man’ syndrome.

So what is it? This is the decline in male hormones later on in life, typically from middle age onwards. Andropause may show up as noticeable symptoms of fatigue, sexual dysfunction, cardiovascular disease, decline of brain function, mood disorders, muscle weakness, reduced fertility and even osteoporosis.1  Testosterone is the most well-known of the so called ‘male hormones’ or ‘androgens’. The decrease of Testosterone levels in older men seems to happen as a consequence of other health conditions especially chronic ones that occur in ageing. So the drop in Testosterone is considered as a barometer of poor health by some researchers and practitioners.2  There are also other hormones involved in male hormone balance, including one called Luteinising Hormone (LH) that comes from the pituitary part of the brain and tells the Testosterone producing cells what to do.

There have been a few types of andropause that have been identified and classified:3

  1. Primary hypogonadism – a fairly rare situation where there is a genetic, anatomical or unidentified cause. Testosterone is low and LH is high on measuring.
  2. Secondary hypogonadism – a common situation where a disease or ill health has caused Testosterone to be low, but LH can be normal or low.
  3. Compensated hypogonadism – also reasonably common as part of the ageing process, Testosterone can be normal, but LH high.

The symptoms that are common to all three types of andropause are ones of sexual dysfunction. It is important to get into the nitty gritty of what these symptoms are, so you might be able to work out if you fit into the ‘andropause’ category. To be considered andropausal you need to show three symptoms of sexual dysfunction, which are: erectile dysfunction, decreased sexual thoughts and decreased morning erections.4 It’s a good time to ask yourself whether this is happening to you!

By far the most common type of andropause is ‘Secondary Hypogonadism’. This happens when the change in hormones can be due to a chronic disease such as diabetes or a heart condition, but is overwhelmingly associated with being overweight or obese.5 Therefore age may not necessarily predict andropause and it can occur much earlier in a man’s life. In fact early andropause worldwide is becoming more common,6 along with lower sperm counts and impotence. So the next question to ask yourself is: Do you have a veranda over the tool shed? You could be at risk of early andropause among other health conditions.


You may also think, “Well, can’t I just take some hormone tablets?” Well, yes you can, but the Endocrine Society’s research shows that Testosterone Replacement Therapy has mixed results. Men report small (but statistically significant) improvements in their libido, body composition, erectile dysfunction and sexual satisfaction while taking the hormone, but show no improvements in mood and brain function.7 So, you may have improvements, but it might not be the full answer and it may increase your risk of other health conditions.8 This is an option that you will have to discuss with your doctor.

Male hormone balance is sensitive to stress, inflammation,9 poor sleep, lack of exercise, being overweight,10 being exposed to toxins (from the outside and inside e.g. smoking, drinking), poor liver function, disrupted microbiome, poor nutrition through a bad diet. So there are many things that are in your power to change that could improve your results, for example: losing weight,11 exercising,12 reducing stress,13 improving sleep,14 improving your nutrition15-20  and with specialised Herbal Medicines .21-24

If you think that you are suffering any of these symptoms, or you want to avoid them happening in the first place, it is best to seek some professional advice. Our practitioners, alongside your doctor, can help develop a plan to get your health and your hormones back on track.


  1. Huhtaniemi IT. Andropause-lessons from the European Male Ageing Study. Ann Endocrinol (Paris). 2014 May;75(2):128-31. doi: 10.1016/j.ando.2014.03.005.
  2. Huhtaniemi IT ibid.
  3. Tajar A, et al; EMAS Group. Characteristics of secondary, primary, and compensated hypogonadism in aging men: evidence from the European Male Ageing Study. J Clin Endocrinol Metab. 2010 Apr;95(4):1810-8. doi: 10.1210/jc.2009-1796.
  4. Huhtaniemi IT ibid.
  5. Cadegiani F Andropause and Men’s Health The 2018 International Congress on Natural Medicine. 2018 June;2:87.
  6. Cadegiani F ibid.
  7. Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-1744. doi: 10.1210/jc.2018-00229.
  8. Yeap BB, Wittert GA, et al. Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations. Med J Aust. 2016 Sep 5;205(5):228-31.
  9. Corona G, et al. Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol. 2006 Sep;50(3):595-604.
  10. Jaworski PE, Ramos A, Nicoleit AR, Bacarin LF, Olivo P Neto. Importance of abdominal circumference and body mass index values in predicting male hypogonadism – A practical approach. Arch Endocrinol Metab. 2017 Jan-Feb;61(1):76- 80. doi: 10.1590/2359-3997000000203.
  11. Grossmann M, et al. A perspective on middle-aged and older men with functional hypogonadism: focus on holistic management. The Journal of Clinical Endocrinology and Metabolism. 2017;102(3):1067-1075. doi:10.1210/jc.2016-3580.
  12. Hayes LD, et al. Exercise training improves free testosterone in lifelong sedentary aging men. Endocr Connect. 2017 Jul;6(5):306-310. doi: 10.1530/EC-17-0082.
  13. Nargund VH. Effects of psychological stress on male fertility. Nat Rev Urol. 2015 Jul;12(7):373-82. doi: 10.1038/nrurol.2015.112. Epub 2015 Jun 9. Review. PubMed PMID: 26057063.
  14. Leproult R. Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men. JAMA 2011;305:2173-2174; Santamaria J. Clin Endocrinol 1988;28:461-470
  15. Yu T. et al Mitochondrial fission mediates high glucose-induced cell death through elevated production of reactive oxygen species. Cardiovascular research. 2008;79(2):341-351.
  16. Hu F, Liu F. Mitochondrial stress: a bridge between mitochondrial dysfunction and metabolic diseases? Cell Signal. 2011 Oct;23(10):1528-33.
  17. Chin KY, et al. Vitamin D is significantly associated with total testosterone and sex hormone-binding globulin in Malaysian men. Aging Male. 2015;18(3):175-9. doi: 10.3109/13685538.2015.1034686.
  18. Hunt CD, Johnson PE, Herbel J, Mullen LK. Effect of dietary zinc depletion on seminal volume and zinc loss, serum testosterone concentrations and sperm morphology in young men. Am J Clin Nutr. 1992 Jul;56(1):148-57.
  19. Fallah A, Mohammad-Hasani A, Colagar AH. Zinc is an Essential Element for Male Fertility: A Review of Zn Roles in Men’s Health, Germination, Sperm Quality and Ferilization. J Reprod Infertil. 2018 Apr-Jun;19(2):69-81.
  20. La J, Roberts NH, Yafi FA. Diet and men’s sexual health. Sex Med Rev. 2017 Aug1. pii: S2050-0521(17)30074-4. doi: 10.1016/j.sxmr.2017.07.004.
  21. Neychev V, Mitev V. Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction. J Ethnopharmacol. 2016 Feb 17;179:345-55. doi: 10.1016/j.jep.2015.12.055.
  22. Adrian Lopresti, Drummond P. Effect of Ashwagandha on vitality, mood, and testosterone levels in healthy men – a randomised, double-blind, placebo-controlled study. 2018. Murdoch University, School of Psychology and Exercise Science, Perth, Australia. Study currently being reviewed.
  23. Rahmati B et al. Effect of Withania somnifera (L) Dunal on Sex Hormone and Gonadotropin Levels in Addicted Male Rats. Int J Fertil Steril 2016 Jul-Sept;10(2):239-44.
  24. Kamenov Z, et al. Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction-A prospective, randomized, double-blind, placebo-controlled clinical trial. 2017 May;99:20-26. doi: 10.1016/j.maturitas.2017.01.011.



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