“Grumpy old man syndrome” is not a medical term, but perhaps it should be. It’s a good way to describe male menopause, according to one of the nation’s top experts in men’s aging.

Dr. Kent Holtorf, medical director of the Holtorf Medical Group, tells Newsmax Health that the signs and symptoms are familiar to middle-aged men: Fatigue, loss of passion, general irritability, lack of sex drive, erectile dysfunction, loss of muscle mass and strength, poor concentration, moodiness, unexplained weight gain, and sleep problems.

Male menopause is caused by an age-related drop in testosterone. It is as widespread as it is devastating to men’s health, affecting some four in 10 American men over age 45.

“It makes men ambivalent to everything, and it really affects a marriage,” Dr. Holtorf says.

The good news: It can be reversed. “Low-T” treatment can give men a new lease on life — if it is done correctly. But getting the right treatment can be tricky.

The hormone that gives men their male characteristics, testosterone, peaks around age 20 and then slowly begins to decline. After age 30, the drop is estimated around
1-2 percent per year, but in recent decades, researchers have noticed that men’s testosterone decline has been accelerating.

 “At any age, average testosterone among men is dramatically lower than it was 10 years ago, which was dramatically lower than it was 20 years ago, and that was dramatically lower than it was 30 years ago,” Dr. Holtorf tells Newsmax Health.

Experts believe this is due to the modern health plagues of obesity, stress, toxins in pesticides and plastics, diabetes, autoimmune diseases, and inflammatory conditions — all of which suppress testosterone production. One or more of these factors will intensify any age-related drop in the hormone.

Testosterone levels can be checked with a blood test, but there is no medical standard for interpreting results. A report by the Endocrine Society, a non-profit medical
organization specializing in hormone research and education, noted:

“The threshold testosterone level below which symptoms of androgen deficiency and
adverse health outcomes occur and testosterone administration improves outcomes in the general population is not known.”

In other words, no one really knows the “cut-off” point where low testosterone should be treated.

Labs, explains Dr. Holtorf, determine what is “normal” based on averages of tests they perform. Readings anywhere between 200 and 1,200 ng/dl may be considered in the normal range, he says, depending upon the lab and the treating physician.

In practice, tests can be misleading. For example, if a patient’s testosterone level is
barely above the low end, that’s considered normal, but it may not be a healthy level for that man.

Dr. Holtorf recommends diagnosis based on three things: medical history, menopausal symptoms, and test for baseline testosterone.

If those factors indicate that testosterone supplementation is warranted, he recommends what he calls a “therapeutic trial” in which testosterone replacement
is prescribed, symptoms are monitored, and blood tests are performed after four to six weeks.

If the therapy is working, testing and symptom monitoring should occur after a further three months. Dosages can be adjusted as needed during the trial period.

After that, monitoring can be reduced to every six months for as long as the patient is taking the hormone.

A fear that testosterone replacement will cause or at least increase risk for prostate
cancer has kept many doctors and patients from taking advantage of the hormone therapy. But as it turns out, such fear goes back to the 1940s and is not based on fact.

A panel of 18 experts convened by the International Society for Sexual Medicine recently reviewed all the available evidence regarding safety of testosterone.
It found that the hormone does not increase risk for prostate cancer or heart disease.

For older men who are experiencing symptoms of male menopause, says Dr. Holtorf,
“Testosterone is exceedingly safe.”

Testosterone prescriptions typically come in injections, creams, gels, skin patches, and sublingual tablets that dissolve in the mouth. Testosterone pills that are swallowed are not widely used as they are not considered as effective and may increase risk for heart disease.

A study at the Malcom Randall VA Medical Center in Gainesville, Fla., analyzed more than 3,700 older men taking testosterone in various forms, and found that injections worked best.

“Our study finds that when testosterone is injected, the effects are stronger in terms of boosting muscle strength and bone density, and there are also indications that it could be safer in terms of cardiovascular risk as well,” says lead researcher Stephen Borst.

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