Healthy Aging in Men

Should "Male Menopause" Be Treated?

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Sweaty, sleepless nights. Inexplicable grouchiness. Weight gain, headaches, and no sex drive. Many women approaching menopause can relate—and so can Mike Coleman.

Last year, a string of restless nights sent the 46-year-old insurance agent from Lineville, Ala., to his doctor. After a blood workup, Coleman was informed that his testosterone levels were below normal, and were likely to blame for the symptoms he'd been experiencing.

"It made sense," he says. "My energy levels were not what they used to be. But you kind of think, ‘How could this happen to me?' "

Coleman's condition isn't all that rare. Quite a few men—up to 25%—have testosterone levels that fall below normal in middle age, and in some cases this transition causes a collection of symptoms that has come to be known as "male menopause" (or "manopause").

"Testosterone levels gradually decline with aging, usually around age 40," says Alvin Matsumoto, MD, a professor of geriatric medicine at the University of Washington School of Medicine, in Seattle. Although the decline is natural, Dr. Matsumoto adds, "that doesn't mean it has no physiological or clinical consequences or shouldn't be treated."

More and more doctors seem to agree. Between 1999 and 2008, the number of prescriptions filled in the U.S. for testosterone gels, shots, and patches—the first-line treatment for most men—increased by more than 400%, to 3.3 million.

Testosterone treatments in men of middle age and older are largely unproven, however, and they carry a risk of serious side effects. The sharp increase in their use has led some experts to wonder whether testosterone is being over-prescribed—and whether the so-called male menopause needs to be treated at all.

Next Page: How common is it?