Do men experience the same type of “change” later in life that women do? Simply put, yes, they do. That’s because the “change,” for women and men, is nothing more than shifts in hormone production and balance.

What is Male Menopause?

The “change” that females go through is called menopause. The male version of that is called andropause. Now, before going any further, this is not a competition. Menopause and andropause are not going to be compared in terms of severity. Men have it much easier than women. But men still go through hormonal changes, which is the topic here. During youth, men produce a lot of androgens (hormones that affect the male reproductive system) like testosterone. Yet, at the same time, they produce minimal amounts of estrogen. This results in a high testosterone-to-estrogen ratio (T/E ratio). A high ratio means a guy’s metabolism is primed, fast, and efficient. He converts food into chemical energy with ease and burns most of it … even at rest. This leads to a muscular physique and little body fat. With a high testosterone-to-estrogen ratio, guys are full of energy, active throughout the day, and have high libidos to match. How do younger men maintain a high T/E ratio? Simple, there’s high testosterone production from the testicles, high production of other androgens from the adrenal glands, and low production of estrogen. Additionally, younger men don’t convert testosterone into estrogen at the same rate that older men do. That’s right, as men age, an enzyme called aromatase becomes much more active and begins converting testosterone into estradiol, the primary form of circulating estrogen. As their level of testosterone drops and estrogen increases, men experience a low T/E ratio. That reversal of hormone balance is called andropause. Andropause is a sure sign that the testicles are making less testosterone and, adding insult to injury, more of it is converting to estrogen through the ever increasing activity of the aromatase enzyme.

Is There an Optimal Testosterone-to-Estrogen Ratio?

No, there’s really not an optimal ratio that hormone specialists like to follow. Andropause is just a matter of losing testosterone and gaining estrogen. The optimal range (not necessarily the normal range) for total testosterone is 700 to 900 ng/dl; for estradiol it’s 20 to 30 pg/ml. Being below the testosterone range and above the estrogen range is indicative of a lower testosterone-to-estrogen ratio. But don’t confuse the testosterone-to-estrogen ratio with the testosterone-to-epitestosterone ratio, which is also referred to as the T/E ratio. That measure is commonly used to identify athletes who might be using performance-enhancing steroids. (An adult male typically has a testosterone-to-epitestosterone ratio of 1:1. Higher numbers might indicate exogenous use of steroid hormones.)

Andropause Affects Body Composition & Disease Risk

A lower testosterone-to-estrogen ratio slows metabolism, decreases lean muscle tissue, and increases body fat. This change in body composition fuels more estrogen production, further lowering the ratio. As the testosterone-to-estrogen ratio drops, men will notice some changes to their shape and size. The most noticeable occurs at the waistline as belly fat accumulates. This is not only unsightly, but it’s also dangerous. An increase in waist circumference is associated with an increased risk of cerebrovascular and cardiovascular disease. The American Heart Association’s risk report clearly states that obesity and, more specifically, an expanding waist size significantly increase the risk of heart and brain circulation disorders.^1,2 Here’s something else you might find surprising since it contradicts everything we’ve been told about testosterone and prostate health. Andropause, with its low testosterone-to-estrogen ratio, may, in fact, increase the risk of prostate cancer. Dr. Abraham Morgentaler, a medical doctor and researcher at the Massachusetts Institute of Technology (MIT), has been studying testosterone, testosterone replacement, and prostate cancer risk for several years. His research has shown that low testosterone levels, not high, are associated with prostate cancer.³ “After all,” wrote Dr. Morgentaler, “if one looks at the natural progression of prostate cancer, it never occurs in men in their 20s when testosterone levels are at their lifetime peak. Instead, prostate cancer becomes increasingly common as men age, when testosterone levels have declined.”⁴ This has led some doctors to postulate that the increased prostate cancer risk in aging men might be due to higher estrogen levels. In a study that examined the ratio of estrogen metabolites relative to prostate cancer risk, elevated levels of the more active metabolite, 16-hydroxyestrone, were linked with an increased risk of prostate cancer.⁵ Why would estrogen be resulting in an increased risk of cancer? Because active estrogen metabolites, like 16-hydroxyestrone, are known to have cell proliferative effects. Could proliferative estrogens be driving the increased risk of prostate cancer in andropause? The verdict is still out, but powerful, active estrogens — not testosterone — might be to blame for prostate cancer.

What You Need to Know

Andropause is very real. And, like menopause, the male version is simply a change in hormone production and balance — mainly the loss of androgens and the subsequent gain of estrogen. If you’re a man approaching his 50s or experiencing some symptoms of a low testosterone-to-estrogen ratio, speak with your doctor about andropause. A great way to start is by testing your hormones and identifying any imbalances.

References:

1. http://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/Obesity/ Obesity-Information_UCM_307908_Article.jsp. Accessed 12/16/2014.
2. http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp. Accessed 12/16/2014.
3. JAMA. 1996 Dec 18;276(23):1904-6.
4. Morgentaler, Abraham. “Destroying the myth about testosterone replacement and prostate cancer.” Life Extension. December 2008. Online version available at http://www.lef.org/Magazine/2008/12/Destroying-the-Myth-about-Testosterone-Replacement-Prostate-Cancer/Page-01.
5. Cancer Causes Control. 2002 Dec;13(10):947-55.