By the time men are between the ages of 40 and 55, they can experience a phenomenon similar to the female menopause, called andropause. Unlike women, men do not have a clear-cut signpost such as the cessation of menstruation to mark this transition. Both, however, are distinguished by a drop in hormone levels. Estrogen in the female, testosterone in the male. The bodily changes occur very gradually in men and may be accompanied by changes in attitudes and moods, fatigue, a loss of energy, sex drive and physical agility.

What’s more, studies show that this decline in testosterone can actually put one at risk for other health problems like heart disease and weak bones. Since all this happens at a time of life when many men begin to question their values, accomplishments and direction in life, it’s often difficult to realize that the changes occurring are related to more than just external conditions.

A gradual hormonal decline

Unlike menopause, which generally occurs in women during their mid-forties to mid-fifties, men’s “transition” may be much more gradual and expand over many decades. Attitude, psychological stress, alcohol, injuries or surgery, medications, obesity and infections can contribute to its onset.

Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting who will experience andropausal symptoms of sufficient severity to seek medical help. Neither is it predictable at what age symptoms will occur in a particular individual. Each man’s symptoms may be also different.

Is this a new phenomenon?

Yes and no. In fact, andropause was first described in medical literature in the 1940’s. So it’s not really new. But, our ability to diagnose it properly is. Sensitive tests for bioavailable testosterone weren’t available until recently, so andropause has gone through a long period where it was underdiagnosed and undertreated. Now that men are living longer, there is heightened interest in andropause and this will help to advance our approach to this important life stage which was identified so long ago.

Increased diagnostic capability

Another reason why andropause has been underdiagnosed over the years is that 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 led 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”.

This situation is changing. New blood testing methods are available and there is an increased interest in men’s’ aging among medical researchers. So much attention is being focused on andropause that major efforts are underway to quickly share emerging scientific information with the international medical community Causes

Starting at about age 30, testosterone levels drop by about 10 percent every decade. At the same time, another factor in the body called Sex Binding Hormone Globulin, or SHBG, is increasing. SHBG traps much of the testosterone that is still circulating and makes it unavailable to exert its effects in the body’s tissues. What’s left over does the beneficial work and is known as “bioavailable” testosterone.

Andropause is associated with low (bioavailable) testosterone levels. Every man experiences a decline of bioavailable testosterone but some men’s levels dip lower than others. And when this happens these men can experience andropausal symptoms.

These symptoms can impact their quality of life and may expose them to other, longer-term risks of low-testosterone. It is estimated that 30 percent of men in their 50s will have testosterone levels low enough to be causing symptoms or putting them at risk.

Importance of testosterone

Testosterone is a hormone that has a unique effect on a man’s total body. Testosterone is produced in the testes and in the adrenal glands. It is to males what estrogen is to females.

Testosterone helps to build protein and is essential for normal sexual behavior and producing erections. It also affects many metabolic activities such as production of blood cells in the bone marrow, bone formation, lipid metabolism, carbohydrate metabolism, liver function and prostate gland growth.

Impact of low testosterone

When there is less testosterone available to do its work, the testosterone target-organ response decreases, bringing about many changes. There is great variability in testosterone levels among healthy men so not all will experience the same changes to the same extent. But typical responses to low bioavailable testosterone levels include:

• Low sex drive
• Emotional, psychological and behavioral changes
• Decreased muscle mass
• Loss of muscle strength
• Increased upper and central body fat
• Osteoporosis or weak bones and back pain
• Cardiovascular risk

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.

Andropause & 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.

Cardiovascular risk*

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.

• Nervousness
• Irritability
• Fatigue
• Depression
• Decreased or absent libido
• Decrease or absent potency
• Memory and concentration decreased
• Fear
• Numbness and Tingling
• Tachycardia, palpitations & dyspnea
• Unnecessary worry
• Loss of Interest

There are several conditions in which you should never use testosterone replacement therapy. These include:

• Breast cancer (in males)
• Prostate cancer

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.

• Liver disease
• Heart or blood vessel disease
• Edema (swelling of face, hands, feet, or lower legs)
• Enlarged prostate
• Kidney disease
• Diabetes mellitus (sugar diabetes)

To help your doctor determine your best treatment plan, you should also discuss the following:

• If you have ever had any unusual or allergic reaction to androgens or anabolic steroids.
• If you are an adult male who plans to have children; high doses of androgens may cause infertility.
• If you are bedridden.
• If you are now taking any other prescription or nonprescription (OTC) medicine, especially anticoagulants (blood thinners)

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.

What should I expect from testosterone replacement?

In various clinical studies, very good responses to testosterone have been reported for men with low-testosterone and they include:

• Improvement in mood and sense of well-being
• Increased mental and physical energy
• Decreased anger, irritability, sadness, tiredness, nervousness
• Improved quality of sleep
• Improved libido and sexual performance
• An increase in lean body mass, a decline in fat mass
• An increase in muscle strength (hand grip, upper and lower extremities)
• Potentially, a decrease in the risk of heart disease

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.

Lifestyle

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.