"Lately, I just can't shake off this fatigue." "I don't feel as motivated to work or pursue my hobbies as I used to."
Many men in their 40s and older may be experiencing unexplained fatigue and a decline in energy. These symptoms may not only be due to a lack of energy or age, but could also be signs of male menopause.
While menopause is often associated with women, men can also experience similar physical and mental discomfort due to hormonal changes.
This article provides a detailed explanation of LOH syndrome, the true nature of male menopause, from its symptoms to its differences from female menopause and its treatment options.
table of contents
What is male menopause?
Male menopause is a general term for various physical and mental symptoms caused by a decline in male hormone (testosterone) levels, mainly due to aging and stress. It is also called LOH syndrome (Late-Onset Hypogonadism), but a key characteristic is that there is considerable individual variation in the timing and degree of the decline in testosterone levels.
There are no epidemiological studies in Japan that have investigated the frequency of this condition. However, it has been reported that the percentage of men with low testosterone levels is about 10% in their 40s, about 20% in their 50s, and about 50% in their 60s. Although fewer men are diagnosed with LOH syndrome, it is safe to say that this is a concern for many men.
Symptoms of male menopause
The symptoms of male menopause are extremely diverse, ranging from psychological and physical issues to those related to sexual function. Furthermore, it is not uncommon for multiple symptoms to appear simultaneously.
| part | Symptoms |
|---|---|
| Neuropsychiatric symptoms | Fatigue, depression, various anxieties, insomnia, loss of appetite, difficulty concentrating, etc. |
| physical symptoms | Cardiovascular system: hot flashes, flushing, cold hands and feet, palpitations, sweating, etc. Sensory system: headache, dizziness, tinnitus, numbness in hands and feet, etc. Musculoskeletal system: muscle weakness, decreased athletic ability, etc. |
| sexual function symptoms | Decreased libido, erectile dysfunction (ED), etc. |
Because men do not have a clear milestone like menopause, they may not realize that their discomfort is due to menopause.
source:Fujita Health University Department of Urology: "Male Menopause Comes into the Spotlight"
Differences between male menopause and female menopause
While both male and female menopause are caused by a decline in sex hormones, their manifestations differ significantly.
The biggest difference lies in the timing and duration. In women, hormone levels decline sharply around the age of 50 due to menopause, but in men, there is no set timing, and it can continue indefinitely from their 40s onward.
| andropause | female menopause | |
|---|---|---|
| cause | Decreased male hormone levels | Decreased female hormone levels |
| season | There's no specific age limit (forever, even after the age of 40). | Five years before and after menopause (around age 50) |
| period | There is no end | Symptoms usually subside about five years after menopause. |
A key characteristic of male menopause is that its end is not clearly defined.
source:Japanese Endocrine Society: "Male Menopause (Age-Related Hypogonadism, LOH Syndrome)"
Diagnostic methods and treatments for LOH syndrome
This section explains the diagnostic and treatment methods for LOH syndrome.
Testing methods for LOH syndrome
If you have any concerning symptoms, consult a specialist medical institution such as a urologist or men's health clinic. Diagnosis is mainly made through a medical interview and blood tests to measure testosterone levels.
Medical interview
In addition to doctors directly inquiring about symptoms, specialized questionnaires may be used to more objectively assess the severity of symptoms. A representative questionnaire is the Aging Males' Symptoms (AMS) score, which has been translated into many languages, but there are also questionnaires developed specifically for Japanese people.
However, LOH syndrome cannot be diagnosed solely through medical interviews or questionnaires. Questionnaires are used only to assess the severity of symptoms and to check the effectiveness of treatment.
Measurement of testosterone levels
Blood tests measure the levels of active free testosterone (FT) and total testosterone (TT) in the body and make a comprehensive diagnosis. In LOH syndrome, only FT may be decreased, or both FT and TT may be decreased.
If both testosterone levels are low, but luteinizing hormone (LH) secreted from the brain is not elevated, a thorough investigation is needed to rule out other underlying factors such as obesity or type 2 diabetes.
Treatment for LOH syndrome
Treatment for LOH syndrome involves lifestyle modifications, symptom management strategies, and testosterone replacement therapy, tailored to the specific symptoms.
Lifestyle improvements
The basis of treatment is reviewing your lifestyle. Symptoms may improve by ensuring you get enough sleep, eat a balanced diet, and get moderate exercise. If your condition does not improve after reviewing your lifestyle, you may be prescribed herbal medicines such as Hochu-ekki-to, which replenishes the vitality of the entire body.
Measures to deal with symptoms
For individual symptoms, medication may be used. For example, ED medication may be prescribed for decreased sexual function, antidepressants or anti-anxiety medications for severe depression or anxiety, and medications for osteoporosis for concerns about decreased bone density.
Testosterone replacement therapy
If blood tests reveal significantly low testosterone levels and symptoms are severe, testosterone replacement therapy (STI) is administered to directly replenish the lost testosterone. In Japan, only intramuscular injections of testosterone preparations are covered by insurance. These injections are administered every 2 to 4 weeks until symptoms improve.
source:Japanese Urological Association and Japanese Society for Men's Health Medicine "Guidelines for the Treatment of LOH Syndrome"
source:Japanese Endocrine Society: "Male Menopause (Age-Related Hypogonadism, LOH Syndrome)"
summary
The physical and mental health problems men experience in their 40s and beyond may not simply be due to a lack of energy or age, but could be based on a clear medical reason: a decrease in testosterone. Just like women go through menopause, men also have a period in their lives where they must confront changes in sex hormones.
With proper examination and treatment, men can regain their vitality and confidence and live energetic lives even during male menopause. If you feel that something is a little off, don't keep it to yourself; consult a specialist.
