‘Manopause’ is a colloquial term that has been thrown about in health magazines and blogs for a number of years now, and one that alludes to some of the age-related changes observed in men from their 30s and 40s onwards. Also referred to as ‘andropause’, manopause has been described as the ‘male menopause’, due to its association with declining sex hormone levels as men age. Some of the symptoms that have been attributed to this time include a decrease in muscle mass, changes in libido and mood issues arising as testosterone levels decline. But does ‘manopause’ really exist and what does the health and medical community have to say about it?
In women, menopause refers to the cessation of menstruation and is officially defined as the point in time one year to the date of the last menstrual period. In contrast, ‘male menopause’ has been described as a slow and gradual process that takes place over many years and as this period is not marked by a specific event (such as cessation of ovulation), there is significant debate among the medical community whether it should likened to the concept of menopause at all. Whilst female menopause is marked by a relatively dramatic drop in female sex hormone levels, male menopause has been described as a slower and more gradual process, occurring as testosterone levels decrease with age. This is where some of the debate arises – at what point in this period does ‘manopause’ truly occur? The other side to the debate arises from our ability to actually ‘diagnose’ menopause. In women, menopause is diagnosed when ovulation ceases and we can identify characteristic signs on a blood test – such as an increase in the hormone FSH and a decline in oestrogen levels. In men, there is no specific feature or event that is diagnostic of ‘manopause’, with the exception of this gradual and poorly characterised decline in testosterone levels. For this reason, some medical professionals prefer the terms ‘androgen deficiency of the aging male’ or ‘testosterone deficiency syndrome’, as these terms are a somewhat more accurate reflection of what can be observed in blood tests. Sadly, many men don’t talk about their health concerns, so the true extent to which ‘male menopause’ affects the general population is poorly understood.
So is Male Menopause a Real Thing?
Whilst male menopause has not been recognised as a true medical diagnosis, research is clear that testosterone levels do indeed decrease with age, and this may play some role in the experience of symptoms such as a decline in muscle mass, energy levels and sexual function. Other signs and symptoms that have been associated with ‘male menopause’ include an increase in body fat, changes in mood, sleep disturbances, reduced self-confidence, declining bone density and reduced libido. That said, many of these symptoms can arise from other causes, such as poor nutrition, poor blood sugar control, impaired thyroid function, weight gain, prolonged stress, inadequate sleep, excessive alcohol consumption and more. For this reason, blood tests can be useful in identifying whether such symptoms relate to an age-related decline in testosterone levels, or whether something else might be responsible. In many cases, it is a combination of factors that could be accounting for such symptoms.
Whilst testosterone levels do, on a whole, decline with age, another confounding factor is that fact that there are plenty of older, healthy gentlemen with better testosterone levels than their younger, ‘pre-manopause’ counterparts. Whilst genetics can certainly play a role in this instance, other factors affecting overall testosterone levels include things like body weight, nutrition, chemical exposure, exercise, muscle mass and alcohol consumption. Body weight and chemical exposure in particular are two of the biggest factors we see affecting men’s testosterone levels in the modern world, and fortunately, two things that are easily modifiable.
Body Weight and Testosterone
In every fat cell in the body, there is an enzyme called aromatase, which converts testosterone through to oestrogen. What this means is individuals with more body fat convert more of their male sex hormones through to oestrogen, and therefore being overweight or obese is typically associated with lower testosterone levels. For this reason, maintaining a healthy body weight is essential to ensuring healthy testosterone levels, and preventing the potential ‘feminising’ effects of excessive oestrogen, such as an increase in breast tissue (colloquially referred to as ‘man boobs’) and weight gain around the thighs and buttocks. We work closely with our male patients to help them achieve and maintain a healthy body weight as they age, as this in itself goes a long way to ensure they feel great and have great testosterone levels to match.
Chemical Exposure and Testosterone
The other major factor we see influencing testosterone levels and ‘manopause’ is chemical exposure. Sadly however, we’re not referring to obscure chemicals that might be found in a chemistry lab, but chemicals that might be found in your kitchen cabinet, in your personal care products or wrapped around your sandwich. The chemicals we’re referring to are BPA and phthalates, two common endocrine disruptors widely distributed in our modern world.
BPA (or bisphenol A) is well-known as a chemical found in plastics. What many people don’t realise is BPA was originally tested as an artificial oestrogen in the 1930s, with the idea of using it as a potential female contraceptive. Whilst BPA certainly affected hormone levels, it was not considered effective enough to serve as a reliable contraceptive, and was shelved as a result. Manufacturers soon found however that BPA makes plastics hard, so it was repurposed for use in the plastics industry, and has since been used widely in things like lunch boxes, Tupperware containers, food packaging, plastic drink bottles and more. When food or drinks are stored or heated in these plastics, BPA can leach into the food and is then ingested into the body, where it can exert its oestrogenic effects.
Due to its widely recognised effects as an endocrine disruptor, the United States Food and Drug Administration have banned the use of BPA in baby’s bottles, and the European Chemicals Agency have listed it as a substance of ‘very high concern’. For this reason, we encourage all our patients to minimise their exposure to BPA as much as possible, especially whilst there is still significant debate as to the extent to which it may adversely impact human health and hormone levels. Some of the best ways to reduce your exposure to BPA include:
- Using a glass or stainless steel water bottle
- Avoiding plastic Tupperware containers and opting for glass or stainless steel instead
- Not heating foods in plastic containers
- Not storing hot foods in plastic containers
- Where possible, substitute fresh, frozen or dry foods for canned
- If buying canned foods, choose BPA-free tins (or ideally, try cooking them beans/lentils/legumes etc yourself)
- Opting for tomato passata from a glass jar, as opposed to tinned tomatoes
- Use a reusable coffee cup, as many takeaway coffee cups are lined with another type of plastic called polyethylene
In recent years, a number of ‘BPA-free’ plastics have been released onto the market, but in many cases, the BPA in these products has been replaced with a similar chemical, such as BPS or BPF. At this stage, we don’t have any long-term data as to how these chemicals affect human health, and some studies suggest they may be just as hazardous as BPA, so we recommend avoiding them where possible.
Similar to BPA, phthalates are another class of chemical that have been flagged for their damaging effects on human health and hormone levels. In contrast to BPA, which makes plastics hard, phthalates make plastic soft, so are used in things like plastic wrap. Phthalates are also added to personal care products to help adhere smell to the skin, which is why you can often still smell that hand-soap on your skin two, three or even four hours after you washed your hands.
So what do phthalates have to do with testosterone? Well, phthalates are considered an anti-androgen, which means they reduce testosterone levels in the human body. Scarily enough, a woman’s exposure to phthalates during pregnancy is thought to possibly play a large role in determining how much sperm her male offspring may be able to make in later life. This means your exposure to phthalates affects not only you, but the health of our future generations as well. In fact, phthalates have been identified as one of the major modern risk factors to fertility, which is why we work so hard with all of our fertility patients to reduce their exposure, especially during preconception and pregnancy.
So how can you reduce your exposure? The best way is to stop using plastics where possible, stop using any personal care products that contain ‘fragrance’ and stop using scented cleaning and household products (such as air fresheners, room sprays, scented candles, scented cleaning products etc). Take a look at your aftershave, deodorant, hand wash, shampoo, dishwashing liquid and so on, and replace them with unscented alternatives or phthalate-free options, such as those suggested in our Resources page. Fortunately, there is more and more consumer awareness about the detrimental impacts of phthalates on human health, and so more and more companies are producing phthalate-free alternatives. To learn more about the topic of phthalates, you can also listen to our first vlog here.
What To Do If You’re Experiencing Symptoms of Manopause
If you’re experiencing symptoms of ‘manopause’, talk to your naturopath or healthcare provider so your symptoms can be properly investigated and addressed. As we mentioned before, there are many, many factors that can be responsible for symptoms like low energy levels, declining muscle mass and changes in mood or libido, and declining testosterone is just one of them – this is why it is essential to be properly assessed, so an appropriate treatment strategy can be determined. If your testosterone levels are on the lower end of the spectrum, your naturopath can help you identify and address factors that might be contributing to lower levels (such as some of those discussed above) and in some cases, may also use herbal medicine and/or nutritional supplementation to support your body’s natural testosterone production. If there are other factors at play – such as weight issues, thyroid dysfunction or nutritional inadequacies – your naturopath can help you address these, to correct the issue at its cause. Just as we support many women through menopause, we too can help you age well and feel great!