Men's Health: Andropause (Male Menopause)

Andropause is the popular term for the condition associated with the physical, emotional, psychological and behavioral changes men experience as they age, but it goes by several aliases including late onset hypogonadism, male climacteric andropause, low testosterone, andropause syndrome, and androgen decline in the aging male (ADAM). Often considered the male version of menopause, and in some respects that's accurate, andropause is somewhat different. More specifically, both conditions represent age-related primary hormone declines, which if untreated can result in a variety of adverse symptoms. Although traditionally attributed to the aging process, many of the negative effects men start experiencing as they get older are caused by a significant decline in testosterone (the primary male hormone) production, resulting in diminished hormonal levels. Hypogonadic, or andropausal, men will frequently notice a gradual loss of energy, decrease in muscle mass, diminished mental focus and memory, increased body fat, reduced stamina, and a noticeable reduction in libido and sexual functioning.

 

Background

Of course testosterone is present in both males and females; however, males produce approximately ten times more testosterone than their estrogen-based female counterparts. Testosterone is the male body’s primary natural hormone, and is integral to male development from birth onward with responsibilities which include: determining gender, moderating pubertal changes; maintaining male potency (libido & sexual functioning) and; the partitioning of bodily muscle and fat distribution. It is also foundational to a male's sense of well-being, and figures prominently in physiological, biological, and sexual health, while influencing sperm production, stress coping capacity, mental acuity (clarity, memory & recall, concentration & focus), bone density, red blood cell production, and immune system support. So it's easy to see why so many elements of health begin to breakdown as andropause progresses.

The primary difference between menopause and andropause is that of speed. Whereas menopause is a rather sudden, succinct, and more defined change andropause isn't. Its onset, and declining testosterone production, begins around age 30 and progresses (at a rate of approximately one percent per year). Researchers estimate the incidences of andropause in our society as follows: ages 40 to 49 at least 2% to 5% of men could be clinically diagnosed with the condition; ages 50 to 59 anywhere from 6% to 30%; ages 60 to 69 between 20% and 45%; ages 70 to 79 from 34% to 70% and; 80 plus at nearly 91%. Virtually all men will experience andropause, but not all men will experience hypogonadic symptoms severely enough to seek medical help. According to the U.S. Census Bureau, approximately 15 million men have low testosterone levels, of which only 5-10% of these men will seek treatment, largely because many don’t realize this condition is correctable.

Symptoms of Andropause

The symptoms of andropause are the same as those of non-age related testosterone deficiency, a.k.a. low testosterone, and are characterized by:

  • Low hemoglobin and possibly mild anemia
  • Loss of bone density which increases the risk of osteoporosis, fractures, and breaks
  • Declining strength, and reduced lean body mass
  • Increased body fat (visceral, adipose, and subcutaneous)
  • Lower energy levels, and reduced interest in usual activities
  • Atypical cholesterol and lipid values
  • Loss of hair thickness and/or amount
  • IMS (Irritable Male Syndrome) - mood swings, irritability, depression, anger, and fatigue
  • Loss of sexual desire (libido) and/or various forms of erectile dysfunction (ED)

Although the above symptoms are most commonly attributed to andropause, this condition is also driven by your level of stress, quality of nutrition, amount of exercise and the environmental toxins you are exposed to on a daily basis. Some of these symptoms can even be caused by other diseases and conditions such as diabetes, thyroid problems, medication side effects, depression, and excessive alcohol use. Testing is important to properly diagnose low testosterone levels.

Testing For Andropause

Actually, routine physicals should expose this condition, but when advanced age is present in conjunction with complaints of traditional andropause related symptoms, physicians will typically employ a simple blood test to measure testosterone levels, along with the levels of both 'bound' (that which is attached to Sex Hormone Binding Globulin - SHBG), and 'free' (unbound) testosterone. Deficiency is usually diagnosed when testing returns a total serum level near or below the established lower limit, which is generally 350 nanograms per deciliter (ng/dl). The blood test should be administered in the morning, prior to daily stressors which can influence testosterone production such as work, exercise, medication, etc. Other measured hormone levels which usually accompany the testosterone measurement include DHEA, FSH, LH, and Estradiol. All blood testing should be conducted from 8:00-9:00 AM, when blood serum concentrations are at their peak.

The Clinical Rational For Testosterone Replacement Therapy

Testosterone replacement should in theory approximate the natural (endogenous) production of the hormone. The average male produces 4-7 mg of testosterone per day in a circadian pattern, with maximal plasma levels attained in early morning and minimal levels in the evening. Ideal testosterone replacement therapy produces and maintains physiologic serum concentrations, without significant side effects or safety concerns. There are different variations (preparations, esters, blends, etc.) of synthetic testosterone each with its own unique properties, and respective methods of action. The most commonly requested testosterone preparations are injectable and transdermal forms.

Intramuscular Injection (IM) testosterone preparations are shot directly into the muscle, and then absorbed into the bloodstream via the capillaries. This is an extremely popular preparation due to its highly accurate dosing, varying time release qualities, and insignificant hepatotoxicity levels.

 Testosterone (Enanthate, Cypionate, and Propionate) is approved by the U.S. Federal Drug Administration (FDA) to treat hypogonadism.

  • Improves mood, memory, energy, libido, and erectile function; increases muscle mass, strength, and bone density; and reduces subcutaneous, visceral, and adipose fat.
  • Possible side effects: abnormal liver function test; acne; gynecomastia; halitosis; vivid dreaming, increased appetite; night sweats

Transdermal (Topical) testosterone preparations can be made in cream or gel preparations and are rubbed into the skin and absorbed through it. Transdermals can be provided in different strengths ranging from 10 mg to 200 mg per milliliter. For optimal benefit, twice daily doses are recommended once upon waking, and again later in the day at consistent times.

  • Testosterone creams/gels are approved by the FDA to treat hypogonadism.
  • Improves...same as IM
  • Possible side effects: same as IM

Monitoring Patients on Testosterone Replacement

Patients on testosterone replacement therapy should be monitored to ensure that testosterone levels are within normal ranges. The prescribing physician should continually evaluate changes in hypogonadic symptoms, and address treatment side effects. Serum testosterone levels should be checked 5 to 7 hours after application of transdermal delivery systems, when concentrations are highest.

Men forty and older should have a PSA test prior to therapy, and it should be repeated in 3-6 months, and then checked annually. A confirmed increase in PSA >2 ng/mL, or a total PSA >4.0 ng/mL requires urologic evaluation. The hematocrit level should also be checked at baseline, at 3-6 months, and then annually. A hematocrit >55% warrants evaluation for hypoxia and sleep apnea, and/or a reduction in the testosterone therapy dosage. Hypogonadal men with osteopenia should be having bone mineral density of the lumbar spine and/or the femoral necks tested after one year.

Living with Andropause

So as you can see living with andropause isn't the downhill spiral that it used be. Now that scientist better understand the syndrome, and healthcare providers are equipped with the tools to combat its aversive symptoms, your golden years can be much more enjoyable.

We can tailor a prescription to the exact strength that you require in the form that's easiest for you to use, thereby transforming this phase of life into one of verve, virility, and continued activity.