The male menopause—does it exist?ForAgainstBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7238.858 (Published 25 March 2000) Cite this as: BMJ 2000;320:858
The male menopause—does it exist?
Be it “andropause” or “climacteric,” do men undergo some kind of hormonal change akinto the female menopause? Adding to the growing debate about men's health, Duncan Gould and Richard Petty argue that some patients need investigation and treatment with testosterone. Howard Jacobs, however, is not convinced.
- Duncan C Gould, consultant,
- Richard Petty, medical director
- The WellMan Clinic, 32 Weymouth Street, London W1N 3FA
- Royal Free and University College School of Medicine, Middlesex Hospital, London W1N 8AA
- Correspondence to: D Gould, Goldcross Medical Services, 20 Harley Street, London W1N 1AL
The term “male menopause” is inappropriate as it suggests a sudden drop in sex hormones such as occurs in women in the perimenopausal state. It is not an inevitability but may occur mainly in middle aged and elderly men when testosterone production and plasma concentrations fall. There seems to be a threshold plasma concentration below which symptoms may become apparent. Testosterone concentrations found to be critical for sexual functioning in men lie around 10.4 nmol/l (300 ng/dl), though there is variation between individuals.1 While some have found that differences in plasma testosterone concentrations within the normal range in young healthy men do not correlate with differences in sexual activity and interest, others have shown that differences in the concentrations of the potent metabolite, dihydrotestosterone, do.2 3
Earlier this century the term “male climacteric” (from the Greek klimacter—the rung of a ladder) was used and is more appropriate as it suggests a decline and not a precipitous drop in hormones concentrations.4 5 A landmark paper of 1944 accurately described symptoms, reversed by testosterone replacement but not by placebo, seen in men suffering from an age associated decline in testosterone concentrations.5 Owing to the similarity between most of the symptoms in men and women the term “menopause” gained popularity and has unfortunately stuck.
An abnormally low concentration of testosterone (hypotestosteronaemia) may occur because of testicular dysfunction (primary hypogonadism) or hypothalamic-pituitary dysfunction (secondary hypogonadism) and may be congenital or acquired.
In the ageing man reduction in testosterone concentration is due mainly to a …