If this isn’t your first time visiting The Change Is Personal, then you know that we’re all about educating women who have questions about symptoms of perimenopause, menopause, and other hormone-related concerns (this is a menopause blog, after all). However, since November is Men’s Health Awareness Month, we decided to take the opportunity to present “the flipside of midlife.”

• What are men concerned with during midlife/andropause?  

• Do they even know what andropause is?  

• Do they have the same symptoms as women?  

• Do they need hormone support, too?

We asked Belmar Pharmacy’s resident men’s clinical hormone specialist, Damian Thrasher, PharmD, to tell us what men talk about most when they call for consultations. Their questions might surprise you. We hope they enlighten you, especially if you happen to be living with a middle-aged man.  

Common Questions About Andropause, Low Testosterone, and Men's Health  

Q: What is andropause, and how can the process be combatted as we age?

Damian’s answer: Andropause happens for men during midlife. It’s sometimes compared to menopause for women, but it’s a little different. For men, the decrease in hormones and onset of symptoms during andropause is typically much slower and a lot subtler than it is for many women.

Testosterone production in men often begins declining in their thirties; roughly 1% to 2% per year, so it’s not usually cause for concern until symptoms begin appearing around midlife (sometimes earlier). For some men, the biggest symptom of andropause is erectile dysfunction (ED), but low sex drive and fewer morning erections may also be signs that something is different. This is when a lot of men first realize their hormones may be lower than they were in their younger years.  

It’s also important to note that ED can be a sign of other health conditions, including cardiovascular disease, high blood pressure, high cholesterol, and diabetes—anything that slows or restricts blood flow within the body. Additionally, some medications, like antidepressants, can contribute to symptoms that mimic andropause. Lifestyle may also be a contributing factor, such as smoking, alcohol use, or lack of exercise.

One of the most sought-after ways to “combat” andropause is through testosterone replacement therapy. Men who talk to their healthcare providers about their concerns are much more likely to get the help they need (and address any other health conditions) than those who just accept sexual dysfunction as the fate of aging.

Q: At what age will andropause symptoms become apparent?

Damian’s answer: As noted, it’s different for everyone. Typically, most men don’t notice the symptoms until their forties or fifties (or even later). They might be dealing with fatigue, brain fog, loss of muscle tone, and other symptoms that are often common during andropause, but they don’t connect the dots back to declining testosterone levels until symptoms show up as low libido, erectile dysfunction, or both.  

Q: Do men with low testosterone get hot flashes like women do?

Damian’s answer: It's certainly possible for men to experience hot flashes if they have a sudden drop in testosterone (like women often experience in perimenopause and menopause), but since men’s hormones typically decrease at a much slower, steadier pace than women, hot flashes aren’t typical. However, triggers like stress or anxiety, thyroid conditions, certain medications, or sleep problems may lead to occasional hot flashes for men.

Additionally, men who've received androgen deprivation therapy (ADT) for prostate cancer may experience hot flashes, because while ADT is designed to decrease testosterone to low levels on purpose, these extremely low levels may be associated with some undesirable side effects.  

Q: How much testosterone is needed to feel better?

Damian’s answer: Like women, hormone levels are a highly personal, individual experience for men. Every man's baseline for testosterone will vary, pertaining to optimal levels needed to feel like themselves. Lab ranges are only part of the picture. Providers look at symptoms alongside lab results, as some men still experience symptoms like fatigue, brain fog, and ED despite conventional test results. That’s why it’s so important to work with a provider who understands hormone replacement therapy. Men should discuss their symptoms and how they feel with their providers, so they can work together to find the “sweet spot” of optimization for their own individual needs.  

Q: Is ED a normal part of getting older?

Damian’s answer: ED does become more prevalent with age, typically affecting men 40 to 70 years old, but that doesn’t mean it happens to everyone, or that there’s nothing you can do about it. And, it’s important to note that erectile dysfunction can be addressed at any age. Occasional ED is one thing, but several months (or more) of ED is considered to be a medical condition. Thankfully, there are also a many therapeutic options available to address the condition, so men can continue a healthy sex life well into old age, if they so desire. It’s important to talk to a healthcare provider to rule out other health conditions (as mentioned earlier) before determining the best course of intervention.

Q: What other treatment options are there for ED besides oral medications?

Damian’s answer: When you think of ED medications, what comes to mind most often is the “little blue pill.” While oral medications are one option, and work well for many men, there are other options available that can be customized for individual needs.  

Belmar Pharmacy offers compounded oral, sublingual, and injectable forms of ED medications. To promote in-the-moment erections, we offer sildenafil citrate and tadalafil in oral and sublingual dosage forms in a variety of different strengths and combinations. As part of ongoing bioidentical hormone replacement therapy (BHRT), compounded testosterone is available in topical, oral, sublingual, and injectable dosage forms, as well as pellet implants.  

Additionally, we offer injectable ED medications in the form of papaverine and phentolamine (BiMix injection), and alprostadil, papaverine, and phentolamine (TriMix). These medications are injected directly into the penis. This allows the drugs to rapidly enter the penile tissue and can prompt more immediate erection onset.  

As mentioned, when it comes to andropause, erectile dysfunction, and hormone replacement therapies, it’s just as personal and individualized for men as it is for women. It’s our goal to help women and men truly understand what’s going on in their changing midlife bodies. We also hope that by providing educational insight about menopause and andropause, men and women can better understand each other, which is often essential in preserving midlife relationships.