Levels of the male sex hormone, testosterone, fall as men age. In women, a sudden drop in oestrogen levels at the menopause can cause many distressing symptoms. Do men also have a 'male menopause' and do they need hormone replacement?

Testosterone levels

Testosterone is made in the testes and production gradually declines from about the age of 40. In most men, this is normal ageing and has no obvious effects. However, very low levels can cause tiredness, low mood, irritability, reduced sex drive, infertility, erectile problems and osteoporosis. Genetic disorders, injury or illness affecting the testes (eg mumps), or rarely brain conditions can cause this.

Is hormone replacement needed?

For most men, reduced hormone levels do not cause any major problems and there is no evidence that testosterone replacement will help. A blood test can measure your hormone level. If it is very low, your doctor may prescribe extra testosterone.

The latest treatment is a once daily testosterone skin patch, which is put on at night. The hormone passes into the blood over a 24 hour period, with highest levels in the morning, just like the natural hormone cycle. The patch is generally well tolerated but can cause skin redness or irritation in some patients. Testosterone is also available by tablet, injection or implant. All treatments may cause prostate changes.

Does 'male menopause' exist?

At the female menopause there is a marked reduction in hormones, an end to periods and symptoms like hot flushes. Compared to this, there really is no male menopause.

Nevertheless, many men struggle in mid-life. There may be work pressures and failed career or financial ambitions. Marital stress and difficult teenagers can make life hard at home. Hair loss, weight gain and sexual difficulties are common. Low hormone levels do not cause these problems.

Talking with your family or friends will often help. If you are still concerned, see you doctor for a chat and a checkup.

For more information, go to www.andrologyaustralia.org.