“Manopuase” is a term mostly perpetuated by the media as a buzzword to explain how men’s physical and mental performance declines during middle age, but while manopause seems like a derogatory label, it does make sense — and let’s face it, it sounds a heck of a lot better than “hypogonadism”; the medical term for those that suffer with little or no sex hormone production. “Muscle & Fitness” talked to Dr. Jeff Foster, a men’s health specialist and medical director at U.K.’s H3 Health to find out what we should know about manopause as we approach and go beyond our 40s, and what the latest treatments are in 2021 so that we can #befitover40 with both our bodies, and our minds.


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What is ‘manopause’?

Testosterone gradually increases in men until they reach around 30 years of age, then it begins to decline at a rate of around 1 percent per year. Your levels of testosterone will be affected by lifestyle factors such as diet, stress levels, and genetic predisposition, but once your levels begin to drop, you stand to lose more than just your sex drive.

For women, the menopause means the drop in estrogen and in men, the manopause, or hypogonadism, basically means a decrease in the production of testosterone. Whether you prefer “manopause,” “hypogonadism,” “andropause,” or any other term, it’s essential to be aware of what they all essentially mean. Due to a lack of awareness, many men suffer with easily treatable symptoms due to low testosterone levels because they simply put them down to the aging process, when in actual fact, there is so much we can do to improve on our quality of life. Testosterone provides metabolic benefits such as muscle mass, bone density, cognitive ability, and many aspects of our personality, it also reduces the likelihood of heart disease and type 2 diabetes, so it makes sense to have an optimum level of “T”!

Jarun Ontakrai

What are the signs of manopause and low testosterone?

Signs that you may be low on testosterone include low sex drive, difficulties gaining or maintaining an erection, low semen volume, hair loss, fatigue, loss of muscle mass, increased body fat, mood swings and, memory issues and “brain fog.”

In the United States, low T is diagnosed when levels fall below 300 nanograms per deciliter (ng/DL). In the England, where Dr. Foster is a practitioner, the British Society of Sexual Medicine uses a different scale where a target of 15-30 nanomoles per liter (nmol/L) is the ideal range for test. In theory, low testosterone levels can be diagnosed by a simple blood test, but treating the problem is more complex because there may be an underlined medical condition such as asthma or depression that is causing your levels to drop. This is where the advice of a men’s health practitioner becomes highly beneficial.

“What we really want to know is the level of free testosterone; the true or ‘bioavailable’ testosterone in our blood,” Foster says. “A fit and healthy man only has about 3% useable testosterone at any one time and the rest is bound to other proteins, mainly sex hormone binding globulin and albumin. This means that for some men, they have what looks like normal testosterone levels but actually the amount that they can really use is less than it should be. This is why it is so important to see a men’s health specialist and not just rely on an online test, or even seeing a regular doctor, as you may be told your levels are normal when they are not.”

Know this before starting testosterone replacement therapy (TRT)

Foster shares this: “Perhaps less scrupulous clinics will just give men, with low testosterone, a replacement therapy (TRT) but actually, there are two things we should always do before starting therapy.”

  1. Figure out why levels are low. Other medical problems can cause low testosterone, for example, thyroid disease, type 2 diabetes, anemia, problems with our pituitary gland in the brain, as well as some medicines or lifestyle factors.
  2. Decide whether levels can be restored by treating the cause. For some guys, a combination of poor diet, no exercise, little or no sexual activity, being overweight, poor sleep, high stress levels, and some medicines (such as asthma, blood pressure, and anti-fungal meds) can affect our testosterone.

“We must not ignore these things,” says Foster. “We must always treat patients holistically by addressing the underlying cause. Investigate their lifestyle and then you can add in TRT if still required. Interestingly, while this is true, some guys find that they are in such a spiral of negativity that changing those bad habits can be near impossible. For those men, we actually give them testosterone early in the process as it provides the energy and motivation that they need to lose weight, eat better, sleep better, and improve their mental health. For those men, they may be able to come off testosterone completely when their lifestyle or other medical problems have been resolved.”

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The latest advances in low testosterone treatments

Advances in technology mean that TRT can be given in the form of a topical preparation, or as an injection. For some, a daily application of a cream or gel is the way to go, while others prefer to inject because it can then mean several weeks between treatments. It is already understood that maintaining a healthy weight, staying active, reducing stress, getting better quality sleep, and keeping alcohol consumption down will have a positive effect on test levels, but there are other advances seen by experts such as Dr. Foster in his clinic in Leamington Spa, Warwickshire.

“We are now using a combination of testosterone replacement and daily tadalafil (a drug similar to Viagra but has a longer half-life),” says Foster. “This seems to produce better outcomes for many patients than the use of testosterone replacement alone. Tadalafil is cheap and very effective and may have other benefits outside of better sexual function, in terms of benefits to your heart.”

Despite our proclivity to announce ourselves as “over the hill” by the time we reach 40, the existence of low test can affect any age group. “My clinic has more than 150 men on treatment and my youngest patient is 26, my oldest is 92,” Foster says. “It can affect any man, and we have nearly 1 million men diagnosed with low T in the U.K. already. (It is thought that at least one in four men over 30 have low testosterone in the United States, and that figure is growing due to our older life span and other, environmental factors.) The key is to listen to your body and look for the symptoms and don’t just accept them as being ‘normal for my age.’” Great advice!

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