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194: Male Menopause

Do men go through menopause? Listen in with sex therapist and author Laurie Watson and couples therapist Dr. Adam Mathews as they talk about what happens to men as they age.

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Male Menopause

Male menopause — a topic that isn’t discussed often, but has peaked the interest of a FOREPLAY – Radio Sex Therapy listener (you know who you are!) In this episode, Laurie Watson teaches co-host Dr. Adam Mathews all about male menopause.

What are some of the facts? 

  • Male menopause is better known as andropause 
  • Andropause occurs when men have decreased hormone levels as they age 
  • On average, men lose 1% of testosterone per year starting around 30 years old

Thankfully, Laurie explains everything you need to know about having low T! Listen now to hear all of the details like how it is different than menopause, the signs of testosterone loss, and preventative measures you can start now. Listen here:

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Adam Mathews:              Today on Foreplay Radio Sex Therapy. We are talking about male menopause. Is that a real thing? How many guys does it actually affect? Am I actually going through male menopause right now? We’ll find out together.

Laurie Watson:                Hello again and welcome to Foreplay Radio Sex Therapy. I’m your host, certified sex therapist Laurie Watson, author of Wanting Sex Again and blogger at Psychology Today and Web MD. And I have with me Dr. Adam Matthews, my cohost who’s a couples therapist, psychotherapist, and president of NCAMFT. Foreplay is dedicated to helping couples keep it hot. Thanks for listening, now onto today’s topic.

Adam Mathews:              All right, Laurie. So today, we are talking about that elusive thing known as male menopause and I want to know if I’m actually going through it. I turned 40 this year. All my friends turned 40. I cry.

Laurie Watson:                You old thing.

Adam Mathews:              I cry at those hallmark commercials. Oh, you know the ones, the Disney commercials with the two little daughters walking through in their dresses, holding hands. I just break down and sob at that. Is that what we’re talking about? Is that what male menopause is? I’m angry a lot. I want to punch people a lot more now that I’ve turned 40 as well. I don’t.

Laurie Watson:                I think this is just you.

Adam Mathews:              Is this just my personality?

Laurie Watson:                This is just you, has nothing to do with male menopause.

Adam Mathews:              Has nothing to do with male menopause.

Laurie Watson:                That’s right.

Adam Mathews:              So, I can’t blame it on something. Can I blame it on just like middle age?

Laurie Watson:                Middle age. Oh, you are so young. Middle age is 55 these days.

Adam Mathews:              No, it’s not. That is a lie.

Laurie Watson:                60 is the new 40.

Adam Mathews:              That is a lie. Everybody said 40 is just a number and my body’s all breaking down all over the place. Can’t walk anymore. I don’t know what’s happening.

Laurie Watson:                You old thing.

Adam Mathews:              I wake up with just aches and pains.

Laurie Watson:                But you worked out today? Yeah, you.

Adam Mathews:              I did.

Laurie Watson:                Well, that’s going to come in handy for male menopause when you get that.

Adam Mathews:              Okay, so what is it?

Laurie Watson:                Okay, so first of all-

Adam Mathews:              Is it an actual thing?

Laurie Watson:                Yeah. It is an actual thing, but it’s a gradual thing. So for women, why we understand women have menopause is there’s an abrupt change around 53 where she stops having periods and her hormones dramatically decrease. Whereas for men, they do have a hormonal decrease, but it’s very gradual. It actually starts at age 30. So yes, you’ve been in it for 10 years.

Adam Mathews:              I’ve been losing like testosterone ever since I turned 30?

Laurie Watson:                Gradually by about 1%, but it’s usually not really observed in terms of men don’t think about it or feel until they’re in their 60s. It’s not the way women feel it. But by about age 50, men have like 80% of the testosterone they used to in 60. They have about 70% of it. And so, men and women both have testosterone. That is the physiological hormone that gives us that sex hunger, that horny desire, that kind of feeling. And men have so much more. And have always had so much more, I mean, even at 70%, y’all are so far ahead of us. It’s crazy.

Laurie Watson:                But one of the things that happens is for men, testosterone gets bound up with proteins. Okay. And so, there are different proteins in our blood. There’s something called the sex hormone binding globulin, and that is a protein-

Adam Mathews:              Sounds like a really fancy hormone there.

Laurie Watson:                Right. It’s a protein and it binds with hormones. And as we age it gets harder for testosterone to get free of this bind. There’s also like estrogen. Estrogen binds with testosterone.

Adam Mathews:              So basically, you’re saying if I just have more of that protein, my testosterone will go up. So, do I just not eat a bunch of eggs or something or a lot of chicken?

Laurie Watson:                No, it has nothing to do with actual protein. It is a protein in the body, in the blood. And it’s something that you can’t impact with diet. So it’s not your protein level from food-based substances. Our body is made up of different things and one of the things it’s made up of is proteins. And so basically, 98% of your testosterone is already bound by protein. And that’s why we measure for men, when they don’t have good desire, we measure something called free testosterone and that’s the unbound testosterone. So like I had a patient who, let’s say he had normal testosterone but his free testosterone was low. So, that’s problematic. What is free gives us a sense of desire. So, yeah.

Adam Mathews:              That’s what you call the horny testosterone.

Laurie Watson:                That’s the horny stuff. That’s the good stuff.

Adam Mathews:              Got it.

Laurie Watson:                Yep. Exactly. And about 15% to 20% of men experience male menopause as a fast decline of testosterone. For some unknown reasons, some men lose testosterone quickly. It can happen at any age. Sometimes even in their thirties, usually not in their twenties. We don’t really know why. It’s called idiopathic, which means we have no idea why this is happening. We’re all idiots when it comes to the reasons. So, we don’t know.

Adam Mathews:              What it’s faster than the normal 1%?

Laurie Watson:                It’s faster. Yeah. And so, it can be really problematic for a man who suddenly is used to having energy, used to feeling desire, used to being able to build muscle really fast. You said you went to the gym, which is great. And you can actually impact your testosterone levels by going to the gym, which we can talk about. But this is how a man first experiences it. Tired, moody, cranky. So, maybe you are having low T. We’ve got to measure you.

Adam Mathews:              Wow. My testosterone.

Laurie Watson:                Your testosterone.

Adam Mathews:              Measure my testosterone. Measure me.

Laurie Watson:                Maybe we should take that out.

Adam Mathews:              Don’t take that out. I want everybody to know that Laurie is trying to measure me. All right. But this is just my testosterone.

Laurie Watson:                That’s right. Just your testosterone.

Adam Mathews:              Very good. So, how do we know if we’re losing testosterone? What are some of the things that would be indicators that it’s declining?

Laurie Watson:                Okay. So one of the first things, and I’m not going to ask you this, Adam, I don’t want to know. TMI. But a decline in erections. So usually, there are fewer morning erections to no morning erections. Also, men feel less desire and their sexual functioning starts to be impacted.

Laurie Watson:                So, it could mean that they get an erection, but then they lose their erection or different ways. They have difficulty climaxing, that kind of stuff. And also, they have a poor response to Viagra or [inaudible 00:06:59], which is the generic for Viagra. And all of them, you know what I’m talking about? The drugs that help with erections. So they take those drugs, and dang, doesn’t work very well, because they have much lower testosterone. And they have cognitive decline just like women, right? Can’t remember my neighbor’s name, that kind of thing. That’s actually cognitive decline. And negative thinking. So again, we’re a little worried about you, mood changes and increased irritability.

Adam Mathews:              I’m losing my keys. I’m forgetting people. I forgot a whole person the other day. Didn’t even know it.

Laurie Watson:                Tell me, you forgot who they were?

Adam Mathews:              Yeah.

Laurie Watson:                You didn’t know that they were your person?

Adam Mathews:              Well, I met with him for like an hour, and then two weeks later I ran into him again and I’d totally forgotten that who they were and why I had met with them. It was sad.

Laurie Watson:                That is total therapist abandonment.

Adam Mathews:              It wasn’t a client.

Laurie Watson:                Oh, that’s good.

Adam Mathews:              I don’t forget about my clients.

Laurie Watson:                Oh, that’s good. Okay. And men go through mood changes where they can also feel like increased anxiety. Like they can feel panicky. So, depression and anxiety can increase.

Adam Mathews:              Okay.

Laurie Watson:                Often men have enlarged breasts. So when you lose testosterone, you lose the ability to build muscle. It’s not fair. It’s dang not fair. Men going to the gym, how fast they build muscle. It’s just so not fair. But anyway, with the loss of testosterone potentially fat replaces muscle essentially, and so it’s harder for them to keep that. Also, their estrogen might go up and so they develop more breast tissue. That can be a problem. Loss of body hair, but not loss of hair on your head. Actually, loss of hair on your head may mean that you have good testosterone. So all those bald men out there, man, they got it going on.

Adam Mathews:              Yeah. You hear that Kevin, you got a lot of Y. Good buddy. Good job buddy.

Laurie Watson:                Shout out to Kevin.

Adam Mathews:              Shout out to Kevin,

Laurie Watson:                But loss of body hair. So like they might lose hair on their chest, on their arms, on their legs.

Adam Mathews:              I kind of wish that would happen to me, but that’s not happening unfortunately.

Laurie Watson:                Waxing.

Adam Mathews:              Waxing.

Laurie Watson:                There you go. Waxing.

Adam Mathews:              No way.

Laurie Watson:                What were you saying about waxing earlier?

Adam Mathews:              I was saying there was no form of wax that I was ever going to touch my body ever. I have too much.

Laurie Watson:                We’ll see.

Adam Mathews:              There is nothing to see, Laurie. She keeps saying that we’ll see some day. There is nothing to see. Not going to happen.

Laurie Watson:                Okay. Men with low testosterone, they experience reduced energy. And so I have patients come in. I had this one guy come in and this changed my mind about testosterone and depression. He had low energy. He was kind of weepy. And most men, if they cry, they don’t weep. But this guy wept. And I said, okay, this is it. You’re so depressed. You are going on an SSRI. I’m done. Sent him to his doctor and he came back and he said, “My doctor says I have low T and wants to try testosterone.” I’m like, “Okay, we’ll give it one week and see.” He got the pellets and this seems like an ad for testosterone. It’s not. It’s a powerful drug. You all need to be under the care of a urologist. But when he came back to see me the next week, no depression. He was buoyant.

Laurie Watson:                He had his drive back, his energy back, depression gone. He said he had sex drive back. It was amazing. But this was a guy who was genuinely low in testosterone. And I just thought, okay, as a clinician, it’s really important for us to think about the body and mind and emotions in a holistic fashion, because it’s not just always the need for an antidepressant. It could be that the person has a hormonal imbalance. And so, we really need physicians to partner with us in our practice as we’re thinking about this.

Laurie Watson:                But men, also the last thing I would say is that they could have a loss of bone density. So this is a big problem. Basically, there are lots of issues that come with the sudden decline of testosterone, much of it mimicking old age.

Adam Mathews:              I was just about to ask, because a lot of these symptoms sound like symptoms of aging. So, how do you tell the difference between maybe male menopause and a faster than usual loss of testosterone versus just normal effects of aging?

Laurie Watson:                I think it is based on these statistics, right? A 70% reduction at age 60, that is normal. But that doesn’t mean it’s in the low range. 70% of a thousand, let’s say 70% of 800, is still in the five hundreds. But I worry when men get closer to 350. Even 400 sometimes I want to take an assessment of their blood values and their clinical symptoms. Clinical symptoms are the ones that we just talked about. Do they have all these other things and their doctor is saying, “You’re still in range, you’re still in a good range.” It’s like, no, I want to talk to your doctor and tell them what I’m seeing.

Adam Mathews:              So, it’s important to get your testosterone levels tested is basically what you’re saying.

Laurie Watson:                Yeah, it really is. Especially if you’re having any of these symptoms.

Adam Mathews:              Okay. Well, can we come back after the break, Laurie? And I want to know what to do about it. Because honestly it sounds terrifying and whether I’m in it or not, I need to know what I can actually do to increase those horny testosterone.

Laurie Watson:                You are not in it. Okay. I will. We will talk about it.

Laurie Watson:                So, we want to remind all of you that we are thankful for the way you’ve shared the podcast. We continue to grow. It is our greatest honor when you share with a friend the work that we’re doing in trying to help people reframe their sexual life in a way that is understandable and not so mysterious, so that they can make positive changes and strengthen their marriages and their partnerships. We would like to invite you to our retreat in November. is where you find us and all the details. Again, we’ve broken that up so that there is a part that you can come to that is less expensive and hear the lecture and do the work on your own, as well as perhaps do the private therapy issue if you would like. And I think the last thing we’d like to say is both of us are doing intensives. So, if you would like to work with us, let us know and call our centers. You can find us at

Adam Mathews:              And if you like what we’re doing and want to help support us, we’d love for you to rate and review us on iTunes. Be super helpful for us. So thanks for listening.

Adam Mathews:              All right Laurie. Let me have it. What are the ways that we get out of male menopause? What can we do about it? Maybe not to get out of it, but how do we change it? How do we make an effect? Put a dent into all of those effects that we are talking about in the beginning.

Laurie Watson:                So, we talked about that men increase body fat, basically breast tissue, and that as testosterone drops it’s more difficult to build muscle. Well, a lot of that is self reinforcing. The more fat you have on your body, the fat itself produces estrogen, which binds with testosterone, right?

Laurie Watson:                So, one of the key things to do if you’re male is to lose the belly fat. It is crazy, but 10 pounds of belly fat, maybe 15 pounds, just a small belly can make a huge difference in terms of a man’s health. Like in 10 years. Men come in and see me and they’re in their forties and they have a little bit of a belly, and they’re just starting to struggle with erections. And I’m like, dude, by the time you’re 50, you’re going to have a huge struggle with your erections. It’s like lose the belly fat now, because belly fat is, of course, an indicator of heart disease, but it also produces this astrogen. Which again, can reduce testosterone. It’s a cycle, right? As we age, lots of things are cyclical.

Adam Mathews:              They start to compound to themselves.

Laurie Watson:                They do, they do. So, do that. So, does that inspire you Adam? First of all, you were just saying you’re going into the gym,

Adam Mathews:              Right. I got to change my diet. That’s the difference.

Laurie Watson:                Okay. How are you going to change your diet? I want a concrete promise.

Adam Mathews:              I’m going to go on a keto, low carb, paleo, intermittent fast.

Laurie Watson:                Golly, you’re going to go for it.

Adam Mathews:              Instead of doing one fad diet, I’m just going to do them all, all at the same time.

Laurie Watson:                I love it.

Adam Mathews:              I’m basically going to eat chicken and pineapple. That’s it

Laurie Watson:                Okay, that’s what you can do, first of all, lose the belly weight. Secondly, you got to go see your urologist. So, I know primary physicians also monitor testosterone and some of them really know their stuff. And of course, that’s always a good place to start. But before you start testosterone, couple things need to be checked. So, your serum testosterone which is your total blood testosterone, your free testosterone, and you need to have your [inaudible 00:16:32] checked, which is basically part of this astrogen that is available in your body.

Laurie Watson:                Because sometimes men with high [inaudible 00:16:41] don’t need testosterone, they need another medication. It’s the old Clomid is what they’re using. I’m not a doctor, this is not medical advice, but my patients basically come back on essentially the generic Clomid because what that does is their testosterone production needs to be boosted. And so, Clomid basically tells the pituitary gland to tell their testes to make more testosterone. You got that?

Adam Mathews:              I think so. The drug is talking to my testes. Got it.

Laurie Watson:                That’s right. It kickstarts your own system. So, you’re making your own testosterone. Because if you take testosterone, again, powerful drug. There are a lot of things we don’t know about taking hormones, especially with testosterone. There’s controversy. So, we want to know what would be smarter and taking testosterone basically stops your body from producing its own testosterone.

Adam Mathews:              Okay.

Laurie Watson:                And it shrinks your testes.

Adam Mathews:              It’s a lot of teste talk today, but we don’t want to shrink. We want them to work on their own.

Laurie Watson:                That’s right.

Adam Mathews:              Right. So, we need to talk to them a little bit using the drug.

Laurie Watson:                Exactly.

Adam Mathews:              Okay. I do not currently have a urologist.

Laurie Watson:                You should. You’re 40.

Adam Mathews:              Okay. Well, I don’t have to have the thing until I’m 50, so what-

Laurie Watson:                What thing don’t you have till you’re 50?

Adam Mathews:              The test that the urologist does.

Laurie Watson:                That’s the gastroenterologist.

Adam Mathews:              Oh, different guy.

Laurie Watson:                Different guy. Totally different test.

Adam Mathews:              So, I don’t need to have that… Okay. Gotcha.

Laurie Watson:                You have to have the prostate check every year.

Adam Mathews:              When I’m 40?

Laurie Watson:                You have to have a blood test that tests your PSA. Absolutely. Every year. And you have to have a digital prostate check every single year.

Adam Mathews:              At 40?

Laurie Watson:                They got to check the oil. Yes, they do.

Adam Mathews:              Got it. Okay. So, how do I find the urologist. We’ll talk about the other guy later, but how do I find a good urologist?

Laurie Watson:                Okay, so you got to ask around. I can direct you in this community for sure. And if you’re in another community, ask your primary. Just say it’s been recommended that I start seeing a urologist. Please, please everybody. By the time you’re like 35, you have to have a PSA blood test for a baseline. A PSA is it checks your prostate specific antigen, which is checking for prostate cancer. Basically, you need that done and you always need a digital prostate exam. Like from the time you’re young, you’re in your 20s, right? Because they want to check the size of your prostate just in case you get cancer.

Adam Mathews:              Okay.

Laurie Watson:                Yep. Okay. So, I would just say smart to start seeing a urologist like once a year. Just the way women see gynecologists. It’s really smart to do that. Okay.

Laurie Watson:                Lift weights, dude. You can raise your testosterone by a hundred points by building muscle mass.

Adam Mathews:              Building muscle mass through lifting weights.

Laurie Watson:                But all these crazy things that say other than testosterone or the drug that tells your body to make more testosterone. Don’t believe any of the ads of this drug will make you feel more desire, will enlarge your penis, build your testes.

Adam Mathews:              All of those, penis enlargement, you can get at the-

Laurie Watson:                The drug store.

Adam Mathews:              No, the gas station. I shouldn’t get any of those. The horny goat weed isn’t really going to do anything?

Laurie Watson:                Right, exactly.

Adam Mathews:              I’ve got it.

Laurie Watson:                Please stop buying that stuff.

Adam Mathews:              Buying it? I invested in it. Just kidding.

Laurie Watson:                Okay, so since 1993, there has been a 500% increase in sales and prescription sales for testosterone. Isn’t that amazing?

Adam Mathews:              That is. That’s really amazing. And part of that is just raising an awareness that this is an issue, right?

Laurie Watson:                Yeah. It’s raising of awareness and also that we understand a little bit more that men need this. So if you were to need testosterone, and that means that you are basically below normal, there are different ways that you can get it. First of all, always go through a doctor. We don’t give the pills anymore because that is processed through your liver and that can be toxic to your liver. So most of the times, the delivery systems are patches, which it’s like a little tiny, silicone or plastic thing that you stick on your body and it delivers through the skin testosterone over time and you need to keep replacing those or injections. Some men give themselves injections every five days or something. There’s a cream or a gel that you can put on every day. You have to make sure it dries and you don’t want to hug your lady.

Adam Mathews:              You don’t have to put those creams on your testes, do you? Can you just put the cream anywhere?

Laurie Watson:                You and your testes.

Adam Mathews:              You keep talking about them. I just want to make sure.

Laurie Watson:                No, you don’t need to put it on your testes. It’s usually underneath your arms. It’s places that don’t generally grow hair.

Adam Mathews:              Oh, I have none of those places. I don’t know what I would take.

Laurie Watson:                Or pellets. Okay, so pellets.

Adam Mathews:              You mean like they give animals? Animal food pellet?

Laurie Watson:                No.

Adam Mathews:              That kind of pellet?

Laurie Watson:                No.

Adam Mathews:              Okay. What’s the difference between a pellet and a pill?

Laurie Watson:                Okay, so a pellet actually is inserted in your body, like in your hip. They make a tiny little incision.

Adam Mathews:              Say what now?

Laurie Watson:                They make a tiny little incision and then they shove these pills into your body and then they stitch you up.

Adam Mathews:              What? I did not know this was a thing.

Laurie Watson:                Yeah, it’s perfect because your body doesn’t like the pill and so it tries to get rid of it. And as it gets rid of it, it delivers the testosterone throughout your body. It’s a great little delivery system to maintain constant testosterone.

Adam Mathews:              How often do you have to do that?

Laurie Watson:                It’s usually once a quarter.

Adam Mathews:              Once a quarter you go in, they slice you open, shove a bunch of pills in there, like quarters worth of pills in there, and then stitch you back up?

Laurie Watson:                No, it’s not like a quarters worth of pills. It’s a tiny pill.

Adam Mathews:              Okay.

Laurie Watson:                It is kind of painful the first day, just afterwards, but they numb the spot up with lidocaine. It’s not that bad.

Adam Mathews:              Okay. That may work for some guys. I’m just going to rub the cream on the testes and go with that.

Laurie Watson:                Okay. Please do not listen to this for medical advice from Adam.

Adam Mathews:              I’m just trying to be average Joe for you.

Laurie Watson:                That’s right. That’s right. Okay. So, there are risks. The research is contradictory. Some say that it raises the heart attack risk. Other people say studies claim that its protective. Maybe it raises the risk for prostate cancer. They’re not sure. Some studies again say it’s protective.

Laurie Watson:                The most typical side effects are acne, tender breast tissue, and sometimes swollen ankles. Some reasons that it would not be given to you is it can raise red blood cell count, which of course if the hematocrit is too high. If your hematocrit, that’s a blood value, is too high, they wouldn’t give it to you because it could increase your risk of stroke. Again, that’s a doctor decision as to what is too high and what is not.

Laurie Watson:                If you’re a prostate cancer survivor, probably out of luck there. And benign prostate hyperplasia, it’s BPH. So, it’s a large prostate. A lot of men get this. It’s not cancerous, but it can obstruct the flow of urine. And so, that is usually fed with testosterone. So, they’re not going to give you it for that. And if you have severe sleep apnea or severe congestive heart failure, those two things, contra indicated of course.

Adam Mathews:              All jokes aside, this is an important issue. It affects a lot of men. It’s not something to be embarrassed about. It happens and there’s ways to really begin to make a difference.

Laurie Watson:                Counteract it, right. So, male menopause is about the loss of testosterone.

Adam Mathews:              Yep.

Laurie Watson:                And it’s not as sudden usually as women, it’s a slow decline. If you do have these symptoms, go see your doc.

Speaker 3:                        You can now call in your questions to the Foreplay question voicemail. Dial 833-MY4PLAY. That’s 833, the number 4, PLAY. And we’ll use the questions for our mailbag episodes.

Laurie Watson:                Hey, help us stay on top here at Foreplay. We’d love it if you would subscribe and share it with your friends. and please take one sec and rate and review us. Thanks so much.

Speaker 3:                        All content is for entertainment purposes only and should not be considered as a substitute for therapy by a licensed clinician or as medical advice from a doctor.