Andropause: The Brick Wall of Male Fertility

Posted on by Paul Turek, MD

He looked great. Fit as a fiddle and sporting a head full of salt and pepper hair.
“Doc, can I still have kids? Been single all my life but just met the woman of my dreams. Be honest, with me Doc, I’m 75 years old!”

Time Waits For No One

What changes occur in the sex-department as men age? Here’s a short list:

  • Testosterone levels fall about 1% per year after age 35 years.
  • After age 40, a man’s age is the same as the probability that he will have erectile dysfunction (i.e. 60% of 60 year olds).
  • Prostate enlargement, which can wreak havoc on a man’s urination patterns, affects half of 60 year olds, and virtually all 80 year olds.
  • Ejaculate volume decreases with age
  • Sperm motility falls by almost 1% per year after age 40 years. On the other hand, sperm counts are generally well maintained.
  • The frequency of ejaculation decreases with age.
  • The time to conception increases with paternal age.

The Brick Wall

These age-related changes in men’s sexual health are generally slow and gradual. However, at some point, a cliff approaches—often termed andropause. At this point, which is generally somewhere between 70-80 years of age, testosterone levels drop more dramatically. Along with this, sexual health issues worsen and sperm production ceases, never to return again. That’s it. You’ve had your fair shake. And, taking testosterone supplements to boost levels won’t help with the sperm issue as supplements act as pretty effective contraceptives themselves. You can argue whether the term andropause is the correct word to describe the changes in testosterone that occur with age (“late-onset hypogonadism” may be a better term), but it is certainly an appropriate word to described the ending of male fertility potential as we know it.
Upon examination of this gentleman’s fertility potential, his hormones and semen quality were remarkably well preserved. I advised him that he should pursue his dream with alacrity as things may change soon and dramatically. In the words of C.S. Lewis, time affects everyone “at the rate of 60 minutes an hour, whatever he does, whoever he is.”