During menopause (when menstruation ends), a woman experiences withdrawal of the hormone estrogen. This can have a great impact on her physical and mental health. The steady decline of the hormone testosterone can have the same global effects in aging men. This phase is called andropause, withdrawal of the androgen testosterone. Although andropause is usually a more gradual process with less obvious symptoms, replacing testosterone may produce dramatic improvement in quality of life for affected men.
Symptoms of andropause affect about 20 per cent of men over the age of 60. In women, menopause can occur suddenly, with estrogen levels dropping to zero. In men testosterone decreases gradually, around one per cent per year from the age of 40. Testosterone affects the brain, skin, liver, muscle, bone marrow, bones and joints, kidney and prostate. A lack of testosterone can affect one or more of these areas of the body.
The symptoms of andropause are quite similar to what some women experience during menopause. Since they occur more gradually, they may not be noticed. These symptoms are:
A doctor concerned about andropause in a male patient will ask about changes in sex drive, strength of erections, and energy. The man will be measured to see if he has lost any height. He will be questioned about symptoms of depression such as anger, sadness, irritability or loss of enjoyment of life. If a number of these changes are noticed, then further investigation is needed. It should be noted that a lowering of androgen is rarely the major cause of impotence (sexual difficulties) in aging males.
Any man answering yes to questions 1 or 7 and three other questions has a high chance of having a low testosterone level.
A physical exam is always the starting point for a patient with symptoms of andropause. After the exam, blood tests for hormone levels and cholesterol levels, liver function tests, and a prostate cancer test are usually done. (The prostate is the gland that sits below the bladder in men. The blood test for prostate cancer is called the prostate specific antigen or PSA.)
A physical exam and blood tests may find a treatable cause for the patient’s symptoms. Levels of testosterone in the blood do not link directly with signs of andropause. However, if low testosterone levels are found in a patient with andropausal complaints, testosterone supplements may be suggested. These supplements may cause dramatic improvement in symptoms.
Testosterone replacement therapy reverses the symptoms of andropause by bringing testosterone levels into the upper limit of the normal range. Different testosterone supplements are available and include injections, oral medications and compounds that can be put on the skin.
Hormone replacement therapy (HRT) in andropause has been reported to increase muscle mass as well as decrease fat mass. HRT does increase bone mass, although not to the level of normal adult bone mass. This may reduce the risk of fractures from falls, a major cause of hospitalization and illness in aging males. However, this benefit has yet to be proven. In addition, improved sex drive, mood, energy, and a sense of well-being are generally reported. HRT improves cholesterol levels, decreasing the total and LDL cholesterol linked to heart disease. In people with heart disease, HRT also appears to increase blood flow in the vessels that supply the heart.
HRT is not recommended for everyone with symptoms of andropause. Those with a history of prostate or breast cancer should not have HRT. Neither should those who have had BPH (Benign Prostatic Hyperplasia – overgrowth of the prostate) leading to obstruction in the urine system. Raised cholesterol and emphysema (a lung disease) in overweight patients raise strong concerns, and require careful monitoring if HRT therapy is pursued.
Side effects of HRT are generally mild. Although the prostate size increases, there is no evidence to date that prostate cancer is caused by HRT. Water and sodium may be retained by the body. This may be a problem in patients with heart failure, high blood pressure, or kidney problems. HRT is rarely toxic to the liver, even after long-term use of testosterone supplements. Gynecomastia, or swelling of the breast tissue, is one harmless result of HRT.
During HRT, the prostate should be examined every six months. Blood tests should be done, including those for cholesterol and the PSA for prostate cancer. The doctor will monitor for improvement of the patient’s symptoms. Therapy will be changed depending on how the person responds and on any side effects.
Andropause is a group of symptoms indicating a lack of testosterone. It may begin when a man is in his forties. While psychological, sexual and physical changes are a normal part of aging, they may be more rapid in certain aging men. Such changes can interfere greatly with the quality of daily life. A screening questionnaire, physical exam and blood tests can diagnose andropause.
Replacing testosterone may improve mood, sexual performance, energy, the amount of muscle and fat in the body, cholesterol levels and bone mass. It remains to be seen if this results in improved health benefits, such as reduced numbers of heart attacks or broken bones. However, the impact on quality of life alone can be significant for aging males.