Can multivitamins (MVs) help treat andropause?

Multivitamins for Andropause: Evidence and Recommendations

Multivitamins alone are not recommended as a primary treatment for andropause, as testosterone replacement therapy is the most effective intervention for men with confirmed hypogonadism and andropause symptoms. 1

Understanding Andropause

Andropause (also called late-onset hypogonadism or testosterone deficiency syndrome) is characterized by:

• Gradually declining testosterone levels (approximately 1% per year after age 40) 2
• Physical symptoms: fatigue, decreased muscle mass, increased body fat, reduced bone density 1, 3
• Sexual dysfunction: decreased libido, erectile dysfunction 1
• Psychological symptoms: depression, anxiety, irritability, impaired cognition 2, 4

Diagnostic Approach

Andropause should be suspected in men with:

• Symptoms of hypogonadism (fatigue, decreased libido, erectile dysfunction, mood changes) 1, 4
• Low serum testosterone levels (particularly bioavailable testosterone) 3
• Exclusion of other causes of symptoms 1

Treatment Options

Testosterone Replacement Therapy (First-Line)

• Most effective treatment for confirmed hypogonadism in andropause 1
• Available in multiple formulations (injections, transdermal patches/gels, oral) 3
• Demonstrated benefits include improved energy, libido, muscle mass, and mood 4
• Potential risks include erythrocytosis, fluid retention, and concerns about prostate health 1

Role of Multivitamins and Supplements

Multivitamins alone have limited evidence supporting their use for andropause symptoms:

• No specific guideline recommends multivitamins as primary treatment for andropause 1
• Certain nutrient deficiencies may exacerbate andropause symptoms but aren't the primary cause 1
• Specific nutrients that may be beneficial if deficient:
  • Vitamin D: Important for bone health; deficiency is associated with lower testosterone levels 1
  • Calcium: Important for bone health, especially if testosterone is low 1
  • Zinc: May play a role in testosterone production, though evidence for supplementation is limited 1

Lifestyle Modifications (Adjunctive Approach)

More evidence supports these approaches alongside appropriate medical treatment:

• Regular physical activity: May help improve energy, mood, and body composition 1
• Balanced diet rich in vegetables and fruits: Benefits overall health and may reduce cardiovascular risk 1
• Weight management: Obesity is associated with lower testosterone levels 1

Important Considerations and Cautions

• Testosterone replacement is contraindicated in men with:

  • Prostate or breast cancer 1, 3
  • Desire for fertility (can cause testicular atrophy and reduced sperm production) 1
  • Severe untreated sleep apnea 1

• Multivitamins should not delay proper evaluation and treatment of andropause 5

• Monitoring during testosterone therapy should include:

  • Hematocrit/hemoglobin (risk of erythrocytosis) 1
  • Prostate-specific antigen and digital rectal examination 1
  • Bone density if indicated 1

Conclusion

While multivitamins may address specific deficiencies that could exacerbate andropause symptoms, they are not a substitute for proper medical evaluation and treatment. Men with suspected andropause should be evaluated for testosterone deficiency, and if confirmed, testosterone replacement therapy remains the most effective treatment approach 1, 4.