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The Male Menopause Myth

It’s commonly known that women going through menopause experience hot flashes, night sweats, moods swings, irritability, insomnia and weight gain, but these same symptoms are known to occur in men as well. They generally occur in men in their 40s to 50s, thought to be due to slowly decreasing testosterone levels, along with other symptoms such as loss of sexual desire or functioning, depression, memory loss, or chronic fatigue.

But what if I told you that I see young men in their 20s coming in to see me with the same exact problems? What I’ve discovered is that it’s really not mainly a hormonal issue, but a problem with their breathing. Let me explain.

What I’ve noticed in all these young men is that they all have in common a relatively narrow upper airway. When examined with a thin flexible camera, the space behind their tongues is very narrow, about 2-3 mm wide. This is mainly due to smaller jaw structures and dental crowding. Whenever someone with this anatomy starts to fall asleep, his tongue muscle starts to relax, and in deeper levels of sleep, it relaxes almost completely, leading to partial obstruction, and awakening. Once awakened, the man turns over. In most cases, they usually don’t like to sleep on their backs for this reason.

Most people compensate very well by sleeping only on their sides or stomachs. However, if there’s anything that narrows the upper airway, either due to inflammation (allergies or a cold), or structurally (fat), the tongue collapses much easier and the person gets less efficient sleep due to multiple arousals.

Inefficient sleep leads to an imbalance of the involuntary nervous system, leading to what are called "vasomotor" conditions, such as sweating, heart palpitations, and temperature fluctuations. So is a young man with a predisposed anatomy is slowly gaining weight, he may experience all the above "male menopause" symptoms.  If these obstructions last for more than 10 seconds, they are called apneas.

If you have more than 10 to 15 apneas every hour, then you may be diagnosed with obstructive sleep apnea. Untreated obstructive sleep apnea can lead to depression, anxiety, weight gain, erectile dysfunction, memory problems, hypertension, glucose intolerance, going to the bathroom often, heart disease, heart attack and stroke. The physiologic stress state that’s created also can lower one’s thyroid and testosterone levels, making it seem like he may have either hypothyroidism or low testosterone. 

So in a sense, the "male menopause" phenomenon does happen, but not for the reasons that you may think. The word menopause literally means cessation of menses. Since men don’t have periods, this is not an appropriate word. Instead, it should be renamed something alluding to the progression of a sleep-breathing disorder. Do you have any of these symptoms or know anyone who’s going through "male menopause"?