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ANDROPAUSE. SHOULD WE INCLUDE MEN SOMEWHERE?

Who said only women are going through ‘menopause’? Men are going through something very similar too. It’s hard to talk to men about it, as they are probably in complete denial, but there are scientific demonstrations and also a name for it: Andropause.

What is andropause and which are the symptoms?

“Andras” in Greek means male and “pause” in Greek indicates a cessation; so literally “andropause” is defined as a syndrome associated with a progressive decrease in sexual satisfaction, or a decline in a feeling of well-being that starts with low levels of testosterone in older men. Now, the medical community is debating whether men are really going through a well-defined ‘menopause’ in the moment their testosterone levels start declining. Doctors who have patients with diagnosed andropause, say that men receiving hormone therapy with testosterone have reported a relief of some of the symptoms associated with so-called male menopause. Why is the medical community still debating about it? Because it is not like menopause where hormone production stops completely, and it does not seem to have all those symptoms. Moreover, men do not go through a well-defined period in their life referred to as andropause.

Andropause, also called late-onset hypogonadism is a common male disorder with a prevalence that increases with advancing age.

Diagnosis of late-onset of hypogonadism is usually based on the presence of some symptoms that indicate testosterone deficiency or a significant testosterone reduction – prominent among them are mainly sexual related symptoms like loss of libido, morning penile erection and erectile dysfunction; and therefore demonstration of low testosterone levels. Some forms of therapy are currently available, but since disparate results have been obtained out of clinical trials done so far, further evaluation of the complex interaction between testosterone deficiency and ageing are necessary. Before initiating any therapy, benefits and risks, should be discussed with patients and in case of poor response to the therapy alternative cause should be then investigated. It has been published what is called “The male climacteric” which depicts symptoms of low testosterone levels characterized by nervousness, reduced potency, decreased libido, irritability, fatigue, depression, memory problems, sleep disturbances, and hot flushes. Familiar symptoms, right? We know what they are talking about! Hypogonadism though is a broad scientific term and it refers to a clinical syndrome which is caused by androgen deficiency or very low serum level, which may affect multiple organ functions and quality of life. However, in contrast to menopause which is universal, well-defined timed process associated with absolute gonadal failure, andropause presents insidious onset and very slow progression.

In contrast to menopause which is universal, well-defined timed process associated with absolute gonadal failure, andropause presents insidious onset and very slow progression.

Many names were given to this process, like male menopause, male climacteric, androclise, androgen decline in ageing male (ADAM), ageing male syndrome, and late onset hypogonadism (LOH). What is considered true andropause refers only to those men who have lost completely testicular function, due to diseases or accidents, or those with advanced prostate cancer that are subjected to surgical or medical castration. The rate of decline in testosterone levels characterized by nervousness, reduced potency, decreased libido, irritability, fatigue, depression, memory problems, varies in different individuals and is also affected by chronic disease, such as obesity, illness, emotional stress, and medications; however, this decline can be decelerated by management of health and lifestyle factors. Amongst all the obesity parameters, waist circumference is one of potentially risk factor for low testosterone and symptomatic androgen deficiency. So, not only us that get thicker in the middle ladies! Testosterone threshold at which symptoms become manifested and detrimental, show subject-to-subject variation. In fact, many men are not symptomatic, although having very low levels of testosterone. Some studies demonstrated that continuous declining of testosterone and other hormones in men from the mid-30s onward can influence the aging-related deteriorations in all body function (for example,  frailty, obesity, osteopenia, cognitive decline, and erectile failure) and testosterone insufficiency in older men has been found to be associated with higher risk of death in the following 20 years of the diagnosis, independently of multiple risk factors and pre-existing health problems. Not all the studies confirmed this finding, therefore more information is needed. Still, these are very important indications in order to help male counteracting the phenomenon.

Therefore, the real difference between male menopause and female menopause is that in women, hormone production stops completely, whereas in men, testosterone decline is a slower process. The testis, unlike the ovaries, still produces testosterone. A healthy man in fact, may be able to make sperm well into his 80s or later. In a case where testosterone levels were to be very low, testosterone replacement therapy may help relieve symptoms such as:

  • Loss of interest in sex (decreased libido)
  • Depression
  • Fatigue

Just as with hormone replacement therapy in women can have side effects, testosterone replacement therapy has potential risks also. Replacing testosterone in fact may worsen prostate cancer and increase the risk of heart disease, for example. Always talk to your doctor before deciding to start any therapy.