Male Menopause: Hormone replacement therapy pro's vs cons

Hormone replacement, Men's Health | May 9, 2014 | Author: The Super Pharmacist

menopause, male, men, hormone replacement

Male Menopause: Hormone replacement therapy pro's vs cons

The efficiency and performance of major systems and organs decline with physiological aging. Although, male subjects do not experience monthly hormonal fluctuations or menstrual cycles like females, the aging process does alter the normal serum levels of reproductive hormones (mainly androgens, including testosterone) leading to male menopause or andropause after the age of 65 to 70 years. In a normal adult male, testosterone is responsible for maintenance of muscle bulk, production of red blood cells, mental and physical well-being, libido and sexual function. The rate of hormonal decline is very slow and gradual in male subjects (unlike females) and may start as early as 30 years. However, males experience no symptoms or alterations in normal sexual drive or performance in most cases.

  • Approximately 10 to 25% of males over the age of 55 years develop hypogonadism; yet according to latest estimates only 5% consider replacement therapy.
  • Most testosterone prescriptions are written for males over the age of 45 years; yet the prevalence of testosterone use in younger males is also increasing at a rapid pace for other indications.

The decision to initiate testosterone replacement therapy is usually made after weighing pros and cons of therapy and overall indications.

What are some risk factors that may increase the risk of male menopause?

Certain risk factors may increase the rate of testosterone decline; such as:

  • Chronic health issues like renal dysfunction (kidney failure) or liver cirrhosis (liver failure)
  • Trauma to testicles
  • Long term chemotherapy or radiotherapy
  • Chronic alcoholism
  • Genetic, inflammatory, hormonal or endocrinological diseases

Are you experiencing male menopause?

According to research published in The British Medical Journal, 6 to 45% of erectile dysfunction cases are caused as a result of low testosterone levels (1). If you experience the following symptoms for more than a few weeks, you may have low testosterone serum concentration.

  • Moderate decrease in the energy levels
  • Unexplained weakness
  • Changes in normal mood or signs of depression
  • Changes in sexual performance (inability to achieve or maintain erection)
  • Changes in the texture or density of hair
  • Unexplained changes in memory and cognition
  • Reduced bone mineral density that increases the risk of bone fractures and dislocations after trivial injuries.

How to manage male menopause?

Most symptoms of male menopause, such as changes in libido, erectile dysfunction and mood disorders, can be managed by hormone replacement therapy that is available in various formulations.

  • Testosterone intramuscular injections
  • Oral tablets/capsules
  • Testosterone gels
  • Testosterone patch
  • Subcutaneous long acting testosterone implants

What are the pros of hormone replacement therapy for the management of male menopause?

  •  Testosterone replacement therapy is effective at improving the sexual dysfunction in males. In addition, a latest report published in Journal of Andrology (2) proposed that hormone replacement therapy helps in improving the response to certain drugs that manage erectile disorders (such as PDE-5 inhibitors or sildenafil).
  • According to research conducted by E. Velázquez (3) and associates, testosterone replacement therapy is effective in short term as well as long term. Besides improving the symptoms of andropause, testosterone therapy also helps in strengthening bones and managing osteoporosis. Thereby, reducing the risk of bone fracture, dislocations and joint displacements significantly.
  • E. Velázquez further discussed the intramuscular formulations of testosterone are the most cost-effective option when compared to trans-dermal approaches often preferred by healthcare providers due to safety and ease of use.
  • Another study conducted by Wang (4) and colleagues provided statistical proof that testosterone replacement therapy is associated with positive changes in mood in hypogonadal men. Testosterone replacement therapy in 51 men over a period of 60 days was associated with significant improvement in energy levels, irritability, anger, aggression, nervousness, depression and overall alertness.
  • Intake of testosterone therapy improves the tissue response to insulin (especially in type 2 diabetics who are also experiencing hypogonadism). Study published in European Journal of Endocrinology (5) indicates that testosterone supplementation resulted in efficient glycemic control, improved tissue sensitivity to insulin, management of adipose tissue stores and an overall reduction in the risk of cardiovascular diseases in diabetic patients
  • Testosterone replacement therapy is also effective against cognitive decline, memory changes and Alzheimer’s disease in patients of hypogonadism (6)

What are the cons of hormone replacement therapy for the management of male menopause?

  • Although, there are several benefits of testosterone replacement therapy in aging males, it carries certain risks as well.
  • Research suggests that long term intake of testosterone replacement therapy can increase the risk of prostate cancer. Data indicates that testosterone therapy for patients with existing risks of prostate cancer should avoid testosterone therapy (7).
  • Howard C. Margolese (8) suggested in a research report that testosterone supplementation in males can increase the hematocrit (concentration of red blood cell) by almost 50% that may lead to circulatory disturbances.
  • Intake of testosterone via oral tablets is strongly associated with alteration in lipid metabolism (especially serum cholesterol levels).
  • Transdermal and sub-dermal implants of testosterone replacement therapy results in skin infections in about 10 to 30% of patients.
  • Intramuscular and transdermal approaches increase the risk of liver infections, liver hepatoma, liver adenoma and liver dysfunction (6).

Other less frequent complications and side effects associated with testosterone replacement therapy are (6):

  • Mood disturbances (excessive libido, aggression, anger, psychosis)
  • Gynecomastia (development of male breast)
  • Sleep apnea
  • Erythema or pruritus (along with other skin conditions)
  • Hypertension
  • Renal dysfunction
  • Edema (due to salt and water retention)

How to minimize the risk of complications and optimize benefits?Vegetables bike

Besides hormone replacement therapy, there are several options that can be employed to improve the symptomology: such as

  • Lifestyle modification (like cessation of smoking, reducing alcohol consumption and intake of healthy nutritious food)
  • Perform regular physical activity
  • Maintain your body weight under recommended range
  • Periodic medical examination for the assessment of prostate function at intervals.


  1. Yassin, A. A., & Saad, F. (2008). Testosterone and erectile dysfunction. Journal of andrology, 29(6), 593-604.
  2. Gould, D. C., Petty, R., & Jacobs, H. S. (2000). The male menopause—does it exist. BMJ, 320, 858-861.
  3. Velázquez M, E., & Arata, G. B. (1998). Testosterone replacement therapy. Systems Biology in Reproductive Medicine, 41(2), 79-90.
  4. Wang, C., Alexander, G., Berman, N., Salehian, B. E. H. R. O. U. Z., Davidson, T., McDonald, V., ... & Swerdloff, R. S. (1996). Testosterone replacement therapy improves mood in hypogonadal men--a clinical research center study. The Journal of clinical endocrinology and metabolism, 81(10), 3578-3583.
  5. Kapoor, D., Goodwin, E., Channer, K. S., & Jones, T. H. (2006). Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. European Journal of Endocrinology, 154(6), 899-906.
  6. Bassil, N., Alkaade, S., & Morley, J. E. (2009). The benefits and risks of testosterone replacement therapy: a review. Therapeutics and Clinical Risk Management, 5, 427.
  7. Fowler JE Jr, Whitmore WF Jr. The response of metastatic adenocarcinoma of the prostate to exogenous testosterone.  J Urol. 1981;126:372-375
  8. Margolese, H. C. (2000). The male menopause and mood: testosterone decline and depression in the aging male—is there a link?. Journal of geriatric psychiatry and neurology, 13(2), 93-101.
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