We men just can’t let women have something entirely to themselves, eh? Women have experienced debilitating menopause symptoms for millennia, and suddenly we said, “why not me?” and invented an analogous condition…well, not exactly… but sort of.

The Difference Between Menopause and “Manopause”

Menopause is the cessation of menstruation and a reduction in the hormones that regulate it. Specifically, hormones released by women’s brains tell their ovaries (and other minor players) to produce different estrogens, progesterone, and other hormones including testosterone. At the completion of menopause, women’s hormonal levels can be profoundly decreased compared to their prior baseline, which causes immediate signs and symptoms and sets them up for some of the negative cardiovascular, musculoskeletal, and neuropsychiatric disorders that are hallmarks of aging. These effects also make it tougher to prepare for physical stressors.

For men, it’s less extreme. Testosterone levels usually peak in our 20s and 30s and gradually decline. For some, it’s less gradual but still not as abrupt as what individuals born with uteruses experience when their ovaries stop producing hormones. On top of that, declining testosterone may be mostly avoidable.

Testosterone Decline: A Matter of Metabolic Health?

Metabolically healthy, fit biological males may not actually be doomed to experience declining testosterone. As it turns out, that gradual decline we see likely corresponds with the negative cumulative effects of metabolic disease, stress, smoking, and other modifiable risk factors for most men. Research like the Cooper Center Longitudinal Study have identified that testosterone levels are inversely associated with body mass index (higher BMIs tend to have lower levels of testosterone) and improve with increasing cardiorespiratory fitness in men up to 80 years old.

At Admire Medical, however, we like to meet people where they are and not where we’d all like to be. For that reason, we understand that most of us (present company included) are not in our healthiest potential states. Even ifwe have a healthy BMI, we may still have other lifestyle factors like excess stress and sleep deprivation that results in our brains telling our bodies “You know what, lets dial back that testosterone. I’m not so sure we’re in the best state to procreate, build fire, and take down large game” … or whatever brains are worried about. We discussed this a bit more in the context of first responders.

Why Prehabilitation Matters for “Manopause”

So, while “manopause” may not be inevitable, it is still a reality for most. For that reason, here’s where it intersects with our world of prehabilitation (or “prehab”).

1. Poor metabolic health is a risk factor for both low testosterone and conditions that require prehab, like end stage joint arthritis, degenerative spinal conditions, and cancer.

2. Low testosterone is very treatable with different formulations of testosterone and related medications. When testosterone increases, so does the responsiveness of muscles to exercise and nutritional stimuli. When muscle mass increases, metabolic disease improves, all else held equal. As a result, fixing low testosterone (“low T”) can be an integral part of a prehab program, especially in the beginning. This provides more bang for your buck when increasing exercise.

3. Low testosterone has other direct negative effects on mood and energy levels, and it can also worsen sleep quality. Fixing this can improve motivation to do all the other stuff we know we should be doing.

The current prevailing wisdom is that responsible testosterone repletion—taking low testosterone and bringing it up to normal physiologic levels—does not increase the risk of developing prostate cancer. Similarly, the same responsible repletion does not increase cardiovascular risks in the short term and may actually improve cardiovascular health in the long term. That being said, certain men at high risk for prostate cancer, those with previously unidentified cancer, and those in remission may not be candidates for testosterone replacement. On top of that, bringing testosterone levels up to those that would make a teenager look like a newborn have many well-documented risks. There is definitely a difference in normalizing low testosterone and grossly overshooting the mark.

Whether it involves medications or lifestyle guidance, we consider good hormonal health an important part of pre-surgical optimization, but it also is important for preventing the same conditions and avoiding the need for prehabilitation in the first place. It is both a symptom and cause of poor metabolic health, but can take time to normalize after starting a diet and exercise program- and who has time for that?