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OSTEOPOROSIS
Apart from the impact that andropause may have on your quality of life, there are other longer-term and silent effects of andropause that are harder to track: increased cardiovascular risk and osteoporosis.
In a healthy individual, bone tissue is constantly being broken down and rebuilt. In an individual with osteoporosis, more bone tissue is lost than is regenerated. We’ve all heard of women suffering from weaker bones, or osteoporosis, after menopause. In men, testosterone is thought to play a role in helping to maintain this balance. Between the ages of 40 and 70 years, male bone density falls by up to 15 percent. Unfortunately, with advancing age and declining testosterone levels, men, like women, seem to demonstrate a similar pattern of risk for osteoporosis. What’s more, approximately one in eight men over age 50 actually have osteoporosis.
The incidence of hip fractures rises exponentially in ageing men, as it does in women, starting about 5 to 10 years later. In Canada, 20—30 percent of osteoporotic fractures occur in men. The incidence of fractures has been increasing in men, whereas it seems to be stabilizing in women – likely due to their lifestyle changes, calcium supplements and hormone replacement therapies (HRT). Low bone density puts one at risk of frequent fractures, associated pain, and in many cases, loss of independence. Wrists, hips, spine and ribs are most commonly affected. Two important consequences of osteoporosis are often seen as a slow but progressive rounding of the shoulders as well as a loss of height and back pain. Particularly devastating seem to be hip fractures, up to one third of patients never seem to regain full mobility.
It is now well accepted that women’s risk of atherosclerosis (hardening of the arteries) increases after menopause. Estrogen replacement therapy seems to reverse this trend.
New evidence suggests that a similar phenomenon occurs in men as their testosterone levels diminish with age. While research is not as complete as for women, the clinical findings point to an association between low-testosterone levels and an increase in cardiovascular risk factors in men.
*A cause and effect relationship has not yet been established in large clinical trials. Further clinical research is needed into this important area of study.
Andropause is often underdiagnosed because symptoms can be vague and can vary a lot among individuals. Some men find it difficult to admit that there’s even a problem. And often physicians didn’t always think of low-testosterone levels as a possible culprit.
So these factors often lead doctors to conclude that symptoms were related to other medical conditions (i.e. depression) or were simply related to ageing and often encouraged their patients to accept that “they were no longer spring chickens”.
But this situation is changing. New blood testing methods are available and there is increased interest in men’s’ ageing among medical researchers. In fact, so much attention is being focused on andropause that major efforts are underway to quickly share emerging scientific information with physicians worldwide.
Andropause is a hormone-related condition of low-testosterone. It usually occurs in males aged 40 and onwards. If you have few of these symptoms you probably have andropause.
There are several conditions in which you should never use testosterone replacement therapy. These include:
In some other cases testosterone replacement therapy may not be right for you. If one of the conditions below is applicable to you, your doctor will decide whether (in your specific case) testosterone replacement therapy is the right solution.
To help your doctor determine your best treatment plan, you should also discuss the following:
In many instances, testosterone replacement in men with andropause can be highly effective and beneficial. It’s not for every man, of course, even those who show symptoms on the previous quiz may have other health problems at the root of it all. Still you should discuss with your doctor if you would be a good candidate for testosterone replacement therapy.
In various clinical studies, very good responses to testosterone have been reported for men with low-testosterone and they include:
With testosterone therapy, one’s attitude improves, reinforcing self-esteem and self-confidence at work, as well as an increased energy at home and in social activities. Most men will feel more vigorous, experience improved energy levels, mood, concentration, cognition, libido, sexual performance and an overall sense of well-being. These effects are usually noted within 3 to 6 weeks. Other potential benefits include maintenance or improvement in bone density, improved body composition, muscle mass and muscle strength, as well as improvement in visual-spatial skills.
Of course, any ongoing strategy to reduce the symptoms and risks of andropause should incorporate lifestyle approaches such as optimal diet, regular exercise, stress-management and the reduction of tobacco and alcohol intake.
Testosterone level decreases steadily with age. Studies show that the level of testosterone is at its peak (100%) around age 20, and ends at only 20%-50% at age 80, with an average decline of 2% yearly. In fact, many men’s testosterone levels diminish to below the deficient threshold of 350 ng/ml at age 50 to 60. Normally, 500-1,100 ng/ml of testosterone should be in the blood. Therapeutic levels range around 1500ng/ml (Dr. Suhaimi Muhammad, Institut Teknologi MARA, Pahang Branch).
For women, the ovaries are responsible for 40% of the body’s production of testosterone. As testosterone levels decline, women will experience fatigue, weight gain, low physical and mental energy, and lack of sexual desire. While HRT often addresses low Estrogen production, often low testosterone and progesterone production is not supplemented.