Do Men Go Through Menopause?

Male menopause — is this a real thing? If so, how would a man know if he’s in it?
—Asking for my husband

Men do not experience a dramatic change in sex hormone levels and fertility in midlife the way women do, but they do experience changes in hormone levels, fertility, and sexual function over time. It is just much more gradual than the female menopausal transition. (I am referring to cisgender men and women here, not transgender men and women, whose hormone levels are influenced by their assigned sex at birth and hormone therapies like testosterone.)

The European Male Ageing Study (EMAS) found that testosterone levels decrease by about 0.4% per year in men between the ages of 40 and 79. An Australian study found that testosterone levels start to decline gradually after age 35 and then more precipitously after age 80.

Interestingly, sperm production does not seem to decline much with age. Measures of sperm quality including motility do decline, though, and chromosomal abnormalities increase with age.

The EMAS found that very few men have symptoms of low testosterone related to aging. For those who experience symptoms, the most common are low energy, depressed mood, low sex drive, decreased lean muscle mass, and increased fat in the midsection — symptoms that sound strikingly similar to what women experience in perimenopause. When testosterone levels are very low, men can develop anemia and brittle bones, but that is quite rare. Erectile dysfunction is not typically due to low testosterone levels.

If a man has symptoms of low testosterone, a doctor can check his levels. Testosterone can be measured with a routine blood test, but, due to normal variations in testosterone levels over the course of a day, it must be measured before 11 a.m. to get an accurate reading.

There are benefits and risks to giving men testosterone when their levels are low. Taking testosterone — usually in patches, gels, or injections — can improve symptoms like low energy, decreased mood, and low sex drive. However, testosterone replacement can cause existing prostate cancers to grow, increase prostate size, and worsen sleep apnea. There is conflicting data that suggest that testosterone replacement may increase the risk for heart attack and stroke.

The takeaway? Men do not have a marked hormonal shift in midlife the way women do, but testosterone levels do decline. For a small number of men, this decline can cause symptoms. If he is experiencing symptoms, it is worth him talking to his doctor about checking testosterone levels.