Male Menopause Syndrome - Andropause

About Male Menopause

When it comes to menopause, everyone thinks of it as only affecting women typically between 45 and 55 years of age after the cessation of menstruation has occurred. During this period of life, due to the decrease in hormone secretion in the body, some physiological changes occur leading to symptoms including easy agitation and irritability, hot flashes, night sweats, sleep disturbance, etc.

In fact, some men also experience a form of menopause. The physical, mental, cognitive and other symptoms that men manifest as they change from young adults to middle-aged then elderly people are collectively known as "male menopausal syndrome" - more commonly called andropause. Modern medicine believes that andropause is caused by the degeneration of testicular function and the decline in male hormone secretion, particularly testosterone. Andropause is a series of pathological changes and clinical symptoms medically known as partial androgen deficiency of aging males (PADAM). About 40% of men will experience andropause between the ages of 40 and 70.

The TCM Causes of Andropause

Male menopausal syndrome has relevant records in many ancient Chinese medicine books. According to the Su Wen chapter “Discourse on the True [Qi Endowed by] Heaven in High Antiquity” (素问﹒上古天真论)of the Huang Di Nei Jing:

“In a male, at the age of eight, the Qi of the kidneys is replete; the hair grows and teeth exfoliated;* at two [times] eight the Qi of the Kidney abounds; Tian Gui 天癸at its zenith, the Jing Essence and Qi overflow, and the Yin and Yang are harmonious, so he can have children; at three [times] eight, the Kidney Qi has reached its normal level. The sinews and bones are strong, hence, the wisdom teeth emerge and [men] grow to their full size; at four [times] eight, the sinews and bones prosper in abundance and the muscles and flesh are full and strong; at five [times] eight, the Qi of the Kidney weakens, and the hair falls and the teeth wither; at six [times] eight, the Yang Qi weakens and is exhausted in the upper sections. The face is worn, and the hair on the head and temples show streaks of white; at seven [times] eight, the Qi of the Liver weakens; the sinews can no longer move; at eight [times] eight, the Tian Gui is exhausted, the Jing depleted, the Kidney in decline, the body fatigued, the teeth gone."

It can thus be concluded that onset of andropause is between 48 and 64. At this stage, the Yang energy is in decline, the Liver and Kidney Qi weak, and the Jing Essence and Blood are increasingly insufficient, resulting in Liver and Kidney Yin deficiency, all of which forms the physiological basis of andropause.

According to the Su Wen’s chapter “Comprehensive Discourse on Phenomena Corresponding to Yin and Yang" (素问·阴阳应象大论):

"At age forty, the Yin energy is at half of its own [former amount]; daily life is in decline; at age fifty, the body is heavy, the ears and eyes no longer clear; at age sixty, the Yang is limp, the Qi greatly declines, the nine orifices no [longer] freely passable; below is depletion, above is repletion, tears and sobs flow."

This gives a certain description of the growth, development and aging process of men, with a more detailed observation of the process of male reproductive growth and decline.

Although most men with male menopausal syndrome suffer from Liver and Kidney Yin deficiency, there are also mutual adjustments between other Zang Fu organs that help ameliorate the symptoms. Therefore, many men can reasonably comfortably go through this stage into old age without additional intervention. Some men, due to the influences of physical constitution, disease factors, imbalance of labor versus leisure, lifestyle, social environment, and mental factors, can experience a series of dysfunctional syndromes if the body cannot naturally adjust itself, and suffer more acute andropause.

Symptoms of Andropause

The clinical manifestations of male menopausal syndrome are complex and diverse due to the different age ranges of occurrence and the influence of individual physical, lifestyle, mental and other factors. However, the main manifestations are the following four aspects.

Psychiatric symptoms: Mainly manifested as changes in temperament, such as depression, melancholy, boredom and desire to cry, or nervousness, oversensitivity, moodiness, or random disorganized thoughts, paranoia, mistrustfulness, etc.
Autonomic nerve dysfunction: Most common presentations are cardiovascular system symptoms, such as palpitations, precordial discomfort, blood pressure fluctuations, dizziness, tinnitus, or feelings of heat and sweating;

Secondarily are gastrointestinal discomforts, such as loss of appetite, abdominal distention, and alternating constipation and diarrhea;

Thirdly are neurasthenia, such as insomnia, less deep sleep with more vivid dreams, easily startled awakening, memory loss, forgetfulness, slow cognitive reaction, etc.
Sexual dysfunction: Mostly loss of sexual desire, impotence, premature ejaculation, low semen volume, etc.
Postural changes: The muscles throughout the body begin to relax, subcutaneous fat increases, the body generally becomes fatter, showing a "blessed state". **

For male menopausal syndrome, in addition to active treatment with acupuncture and herbs, practitioners should also introduce some common knowledge about andropause to patients so that they can understand their physical and psychological changes, relieve their concerns, and encourage a positive and optimistic attitude for this life change. Advise patients of the importance of treatment for a more comfortable transition, to engage in more outdoor and social activities and to develop regular, healthy living habits.

In addition, if family members and friends can understand, sympathize with, and help take care of the patient's physical and psychological changes, this will be extremely helpful in alleviating the patient's symptoms. Generally, after treatment, the symptoms of most patients can be significantly relieved. For those with more severe symptoms taking medications, the triggers that aggravate the disease should also be actively pursued and dealt with.

Editor’s notes:

*Tooth exfoliation: the process of shedding primary, “milk-teeth” and their replacement by permanent teeth.
**Blessed state:A euphemism for being fat/overweight.

About the Author

Professor Guozhi Wan 万国志教授 graduated from the Heilongjiang University of Chinese Medicine in 1973. After graduation, he stayed at the school to teach and became one of the founders of its Acupuncture Program. During his tenure there he also served as its Director of the Meridian Research Office and the Director of the Acupuncture Clinical Teaching and Research Office. He currently serves as the Vice President of the University’s U.S. branch.

After immigrating to the U.S. Dr. Wan became a practicing licensed acupuncturist, holds a Ph.D. in Oriental Medicine from the American Liberty University, and invented a painless needle insertion technique. He has taught acupuncture at the University of East-West Medicine (DAOM Program), Academy of Chinese Culture & Health Sciences, American College of Traditional Chinese Medicine and at Five Branches University (DAOM Program). Dr. Wan has been engaged in teaching and clinical work for more than 40 years and regularly exhorts his students-- “With just a needle, a handful of grass, and a pair of hands, we are not afraid to travel around the world!"

Translation Resources

Huang Di nei jing su wen, Unschuld, P. U., and Tessenow, H., University of California Press, 2011.
On the Standard Nomenclature of Traditional Chinese Medicine, Xie, Z., Foreign Language Press, 2003.
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