Andropause/Male Menopause – Symptoms and Diagnosis

While not as severe as the female menopause, the male version is lengthier, usually lasting 15 to 20 years. About 40% of men in their 40s, 50s and 60s experience some degree of lethargy, depression, increased irritability, mood swings, and difficulty in attaining and sustaining erections that characterize andropause.

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The concept of a male andropause has been more controversial than that of the female menopause, with many arguing that it doesn't even exist. Part of the reason for the controversy is that, in contrast to women, men do not have a clear-cut external sign, namely the cessation of menstruation.

A man often begins to experience changes in his body somewhere between the ages of 40 and 55. These bodily changes may be accompanied by changes in attitudes and moods. The aging process alone can not be responsible for this problem as well over 40% of males remain sexually active at 70 years of age and beyond.

Acute andropause in men is relatively uncommon, compared to acute menopause in women, because testicular function declines gradually in most men. There are a number of other causes, however, for acute testicular failure in adult men and these include: viral infections such as mumps, surgical removal of or surgical injury to the testes and male reproductive tract, diseases when the immune system attacks and destroys the testes such as variations of systemic lupus erythematosis, subtle genetic abnormalities which permit normal adult development but lead to premature testicular failure, generalized vascular diseases such as diabetes, chemotherapy, and pituitary tumors (rare).

The second form of this syndrome, while more common, is more insidious since it occurs gradually. It is often confused with male midlife psychological adjustment disorders because it exactly mimics depression in midlife men. Some known contributors to this condition are excessive alcohol consumption, smoking, hypertension, prescription and non-prescription medications, poor diet, lack of exercise, poor circulation, and psychological problems.

Male hormones decline gradually. Testosterone (from the testes), human growth hormone (from the pituitary), and DHEA and androstenedione (from the adrenal gland) levels all begin to drop. For many men this does not occur until their 60s or 70s but there are others where it occurs much earlier. In addition, there are proteins in the blood which bind testosterone into a biologically inactive form sex hormone binding proteins or globulins. Their levels can rise in response to many conditions including medical disorders and exposure to other hormones such as phytoestrogens (estrogens derived from plant sources such as soy) and environmental estrogen-like compounds (pesticides, hormones used in agribusiness to produce fatter animals, etc.) As an example, there is some data suggesting that men on low fat or vegetarian diets have lower testosterone levels. The overall effect of rising sex hormone binding proteins is that there is less bio-available testosterone.

Typical symptoms include:

This list sounds a little similar to women in menopause because it is the same condition. The relationship between the ovaries, estrogen, the brain, and the pituitary are the same as the relationship between the testes, testosterone, the brain, and the pituitary.

The diagnosis is simple measuring either free testosterone blood levels or computing the Free Androgen Index (FAI) which is [total testosterone x 100 / sex hormone binding globulin]. There is some controversy as to what level of total blood testosterone in men is normal with low end values ranging from 250-400ng/dl. Free testosterone in men should be well within the range of 300-1100ng/dl with the FAI between 70-100%. At a FAI of less than 50%, symptoms of andropause appear.

Risks of replacement therapy. Though often suggested, there is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer. Men using synthetic testosterone supplementation should have their serum lipids carefully evaluated and rechecked periodically. Using a natural testosterone is safer than using a synthetic form, but may require the transdermal route of administration.

As a general principle, whenever any hormone is administered, the gland which normally produces it ceases to function and recovery when therapy stops can be variable. Patients with borderline low testosterone levels may be committing themselves to lifelong therapy if they start with testosterone replacement.

Benefits of replacement therapy There is no doubt that the administration of testosterone to men with true testosterone deficiency will improve their health and sense of well being. The symptoms listed above should disappear. Unfortunately impotence, or the inability to sustain and erection, does not respond well to testosterone therapy except perhaps in men with severe hormone deficiencies. This comprises approximately 8-16% of men presenting themselves to physicians with erectile disorders. There is no evidence that administering testosterone to men with borderline low testosterone levels will improve sexual functioning, although libido may be enhanced.

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Andropause/Male Menopause - Symptoms and Diagnosis

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