Andropause

Andropause is the medical term used to describe the result of low testosterone in the male body. Between the ages of 40 to 55 men may experience a phenomenon that is similar to female menopause. Unlike women who can mark menopause through the cessation of their menstrual cycle, men do not have a clear-cut signpost. However, Andropause is distinguished by a marked drop in hormone levels. This drop can account for changes in attitude, mood, fatigue, loss of energy, loss of sex drive and physical agility.

Studies also show that this decline in testosterone in a man can put them at greater risk for other health problems, such as heart disease and osteoporosis. Since this all occurs at a time in life when many men begin to question their values, accomplishments and possible direction in life, it can be difficult to differentiate between the changes that are physical and those that are emotional.

In women, menopause occurs over a two to seven year period in time. However, men’s transition may be more gradual and extend over several decades. Psychological stress, alcohol use, injuries or surgeries, medications, attitude, obesity and infections can all contribute to the date of onset and how long it takes for a man to transition through the decline in testosterone levels.

Andropause was first described in the medical literature in the 1940s. But, the ability to diagnose it properly has only just now become available. Since men are now living longer there is a heightened interest in the ability to maintain a healthy lifestyle in an important stage in life. Symptoms can be vague, vary quite a bit and some men find it difficult to admit there is even a problem.

Today, physicians know that Andropause is a fairly common condition and the incidence increases with age. It is estimated that two to five percent of men between 40 and 49 suffer from Andropause but the incidence increases to six to 30% in men between 50 and 59. That number jumps to 34 to 70% once a man reaches age 70.

Conventional means of treatments include testosterone replacement therapy, but treatment options remain a controversial area. Instances where physicians may recommend testosterone replacement include when men have a clear bone density loss, and in treating sexual dysfunction where Viagra or other prescribed remedies don’t work. Another benefit may be using testosterone when attempting to maintain body composition and muscle, for instance, in patients fighting cancer.

However, using testosterone replacement therapy is not a benign treatment. Men who consider this treatment should have their PSA levels checked because this type of treatment protocol can increase the risk of prostatic cancer. Other risks include increased risk of stroke, increasing liver toxicity and breast development as well as shutting down the production of sperm.

Another consideration is that many of the active androgens in the body are not produced in the testes but actually in the adrenal glands. These adrenal glands are small glands that sit on top of the kidneys. Although these particular androgens are not very strong they are converted to stronger ones: testosterone and DHT.

Despite many years of intensive research doctors still don’t know a great deal about the specific function of DHT but saying it has a protective role decreasing the incidence of cardiovascular disease and various forms of cancer. DHT is considered the mother hormone. In other words, it is a hormone that is later converted into others, including testosterone. It reaches peak production in men during their late teens and 20s and from that point decreases over the remainder of a man’s lifetime.

Other hormones which also impact the signs and symptoms of andropause are growth hormone and thyroid hormones. Growth hormone levels will control the production of insulin that affect the body’s composition. The pituitary hormone that stimulates the thyroid to make thyroid hormone is called thyroid stimulating hormone. As men get older thyroid stimulating hormone decreases and the thyroid becomes less responsive. As a result there is solid decrease in the circulating amount of hormones which can result in hypothyroidism. It is estimated at close to 20 percent of elderly men will suffer from decreased thyroid hormone while going through Andropause.

Diagnosis and treatment of this condition remains controversial because after the age of 50 it is not known what the level of serum testosterone would define a deficiency. At this time there are two standard deviations below the normal values for young men that would be considered abnormal. Interestingly, men can have a large variation in serum testosterone levels over time. This means that there may be a normal level on one day and a decreased level on the next. This makes it important to monitor levels over an extended period of time before defining that an individual has a deficiency in testosterone.

At this point there have been a number of studies which show that replacement therapy in men has positive effects but unfortunately, these studies are approximately 20 years behind studies done for hormonal replacement therapy in postmenopausal women. Benefits that have been seen include improved sexual function, improved erectile function, improved mood, improved body composition and strength, increased bone density, and improved cardiovascular system.

However, despite all of these positive benefits of replacement therapy, there have been a list of negative effects which have been compiled over years of study. Men with a history of prostate cancer or breast cancer may never be candidates for testosterone replacement therapy because these cancers grow more rapidly in the presence of testosterone. Other negative effects include fluid retention, liver toxicity, problems with fertility, sleep apnea, tender breasts or enlarged breasts, increase red blood cell concentration and growth of the prostate.

Once hormone replacement has been started it is usually maintained for life and monitoring is a lifetime commitment. Unfortunately, there is no clear-cut standards for monitoring or defining adequate levels. In general, physicians start with a low replacement and patients are checked every two to three months. Individuals who also suffer from hypothyroidism should first be treated for it.

Resources:

Pharmacotherapy: Testosterone and Andropause

http://www.ncbi.nlm.nih.gov/pubmed/10453966

Reviews in Urology: Testosterone Replacement in Men with Andropause

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472881/

Journal of Gerontology: Andropause: Clinical Applications in the Decline of Serum Testosterone

http://webmedia.unmc.edu/alliedhealth/nichols/Andropause%20and%20Men.pdf

American Journal of Therapeutics: Management of the Cardinal Features of Andropause

http://www.med.unc.edu/~mcoward/urology/Management%20of%20the%20Cardinal%20Features%20of%20Andropause.pdf

University of Manchester: Symptoms of Male Menopause Unzipped

http://www.sciencedaily.com/releases/2010/06/100616171639.htm

Harvard Health Medical Publications: Hormone Replacements: the Male Version