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Andropause: Overview, Symptoms & Treatment*

Andropause, or the name by which it is sometimes referred, “male menopause,” is rather misleading and is also a rather controversial concept. The word is sometimes used to describe a supposed medical phenomenon in middle-aged men. Proponents believe that it represents the effects of a reduction of the production of the hormones testosterone and dehydroepiandrosterone, and the consequences of that reduction, which is associated with a decrease in Leydig cells.

The term andropause is probably a misleading choice of terminology (as is the term “male menopause”), because it suggests an equivalence with female experienced menopause. In women, however, it means a complete and permanent physiological shutting down of the reproductive system. This does not occur in men. Unlike the term menopause, the word “andropause” is not currently recognized by the World Health Organization and its ICD-10 medical classification.

The term “andropause” is sometimes used, however, in peer-reviewed journal articles, both with and without scare quotes; however, there is on-going professional disagreement about whether or not andropause should be considered a normal “state” (the term used by MeSH), or a disorder. A steady decline in testosterone levels in men with age is well documented, but there is disagreement over how exactly a “normal” or “healthy” state should be defined.

Andropause considered as a “state.”

The impact of low levels of testosterone has been previously reported as early as the 1940s. Symptoms, such as loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. In 1944, Heller and Myers in a study found that their subjects had lower than normal levels of testosterone and that symptoms improved dramatically when patients were given replacement doses of testosterone. Andropause has been observed in association with Alzheimer’s disease. In one study, 98.0% of primary care physicians believed that andropause and osteoporosis risk were related. The term “symptomatic late-onset hypogonadism” (or “SLOH”) is sometimes considered to refer to the same condition as the word “andropause”. Some researchers prefer the term “androgen deficiency of the aging male” (“ADAM”), to more accurately reflect the fact that the loss of testosterone production is gradual and asymptotic (in contrast to the more abrupt change associated with menopause.) The “D” is sometimes given as “decline” instead of “deficiency”. In some contexts, the term “partial androgen deficiency in aging males” (“PADAM”) is used instead.

Andropause considered as a “disorder.”

Proponents.

Its proponents claim that it is a biological change experienced by men during mid-life, and often compare it to female menopause. Menopause, however, is a complete cessation of reproductive ability caused by the shutting down of the female reproductive system. Andropause is a decline in the male hormone testosterone. This drop in testosterone levels is considered to lead in some cases to loss of energy and concentration, depression, and mood swings. While andropause does not cause a man’s reproductive system to stop working altogether, many will experience bouts of impotence.

Some of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond, a lay person. According to Diamond’s view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, generally between the ages of 40 and 55, though it can occur as early as 35 or as late as 65.

The term “male menopause” may be a misnomer, as unlike women, men’s reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives (at age 90 or older). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.

The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.

Opponents.

Many clinicians believe that andropause is not a valid concept, because men can continue to reproduce into old age. Their reproductive systems do not stop working completely, and therefore they do not exhibit the sudden and dramatic drops in hormone levels characteristic of women undergoing menopause. It should be noted that in some men their sexual system does shut down before the age of 60. There is a complete loss of libido, erectile function and orgasmic ability. More research needs to be done to describe this condition and its effects.

Others feel that andropause is simply synonymous with hypogonadism or low testosterone levels. Opposition is not limited to the US.

Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition. For example, people who are overweight may be misguided into treating a new illness rather than addressing the lifestyle that leads to their being overweight. Similarly, energy levels vary from person to person, and for people who are generally inactive, energy levels will automatically be lower overall.

While it is true that active and otherwise healthy men could, in theory, develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.

Suggestions for treatment.

Although there is disagreement over whether or not andropause is a condition to be “diagnosed” and “treated”, those who support that position have made several proposals to address andropause and mitigate some of its effects.

* Morley emphasizes the importance of response to treatment, as well as testosterone level and identifiable symptoms.
* Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise.
* Diamond (a lay person) believes that depression is one of the most common problems of men going through andropause, and feels it is greatly under-diagnosed in men, with serious consequences.

Several intervention strategies have been found to be effective. These include:

* Exercise, dietary changes, and stress reduction
* Selective androgen receptor modulators have also been proposed.
* Measure Testosterone Levels. The best measurement of hormonal status is either free testosterone or bioavailable testosterone. These measurements may only be available through specialty laboratories. These tests, if need for them is indicated, should be ordered by your urologist or primary care physician. However, this field is complicated, and a specialist should be strongly considered for consultation if a diagnosis of andropause has been made. At Men’s Clinics of Americas, our physician will recommend that you see your primary care physician for follow up testing if needed.
* Hormone replacement therapy. This may include the prescribing of testosterone cream (please see “Testosterone” on this website). Testosterone replacement may be done in a variety of ways, however, the easiest way to obtain a prescription for Testosterone gel or cream, which is applied regularly as recommended by the prescribing physician. It is relatively safe, has low incidence of side effects, and is extremely easy to apply. Further, by application in the morning, it works similarly to the decr
ease in testosterone naturally made by your own body, as the day progresses.

At Men’s Clinics of America, our physicians will prescribe testosterone replacement therapy for such conditions as low libido or andropause, as indicated.

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  • Orlando Terneny, MD - Board Certified Internal Medicine Specialist in Andrology

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