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Andropause

Andropause is a natural slow decline in hormones that happens as men age. It is common in men over 50years of age though it can occur in younger men. It describes an emotional and physical change that many men experience as they age. Though andropause is associated with aging, it may also occur with significant hormonal alterations. While it has been known for a long time that the production of hormones by the testes slowly decreases as men age, interest has developed only recently in the clinical implications of andropause.

Andropause is also referred to as male menopause, male climacteric andropause, male andropause, late onset hypogonadism, androgen decline in the aging male (ADAM) or viropause. Andropause does not affect all men unlike in women, in whom menopause occurs universally.

As men age, the level of he male sex hormone, testosterone, in the their body decreases. The range of the decrease can vary widely in difference men. Hypogonadism can cause a sudden decrease in level of testosterone. Classified as either primary or secondary, hypogonadism should be ruled out in patients experiencing symptoms of andropause.

Symptoms of andropause can vary from one man to another. These may include lethargy or decreased energy, decreased libido or interest in sex, erectile dysfunction with loss of erections, muscle weakness and aches, inability to sleep, hot flashes, night sweats, depression, infertility and thinning of bones or bone loss. The onset of these symptoms is usually slow and may mistakenly be attributed to the natural process of ageing.
The significant symptoms are :-
  • Decrease in libido or sex drive / desire and the quality and duration of erection. A decrease in nocturnal erections is a significant sign of decrease androgen level.
  • Mood changes. This can also be associated with decreases in intellectual activity, fatigue, depression, anger and poor spatial orientation.
  • Decrease in lean body mass, along with decreases in muscle mass and strength.
  • Decrease in body hair.
  • Decrease in bone density resulting in osteoporosis. Osteoporosis can often lead to increased incidence of bone fractures.

It is important to remember that different men may have these symptoms in varying degree and not all of these symptoms need be present to identify andropause. Andropause can be diagnosed by measuring the level of testosterone in the blood. One can measure the total testosterone level but it is the free form of testosterone that causes the symptoms. Usually testosterone deficiency is not the most common cause of impotence; other causes include atherosclerosis, diabetes, hypertension, and use of certain medications. These factors, as well as previous genital trauma and other aspects of the patient’s medical history, are important in diagnosing andropause.

The level of testosterone in the body is controlled by complex mechanisms and the level can vary from one day to another. So it is important to look at the levels over a period of time. It is not yet known what level of serum testosterone defines a deficiency in older men. Generally, it is accepted that two standard deviations below the normal values for young men is considered abnormal. Different men may need varying levels of testosterone for optimal function of of their brain, bone, prostate or muscle cells. Therefore, it would be incorrect to say that there is one standard level of testosterone that should be achieved by all men. Rather, the patient and the andrologist working together need to find the level of testosterone that is most effective for the particular patient.

Once the diagnosis is made, doctor may advise the patient to undergo hormone replacement therapy. Replacing testosterone can have a significant benefit particularly in older men with an improvement in well-being, improved sex drive, improved sexual function, improved muscle mass and strength and an increase in bone density. There are now several alternatives available for testosterone replacement therapy in the form of injections, skin patches and creams that can deliver testosterone into the blood in a non-invasive way. Men receiving hormone replacement must must be monitored for signs of prostate disease, dyslipidemia, hepatotoxicity, erythrocytosis, and other side effects.

Diagnosing andropause needs a thorough understanding of the complex interplay of the hormones and at our centre we have a dedicated endrocrinologist to help in the diagnosis and management. The treatment can be extremely satisfying.