September 30, 2019 By Dr Arockia Virgin Fernando
What is Andropause?
Andropause or male menopause is defined as a condition with a decrease in sexual satisfaction or a decline in the feeling of general wellbeing in older men.
Andropause is a common disorder which increases in prevalence with advancing age. It is because of the reducing levels of testosterone due to the age. This is, however, a completely different situation from that of menopause in women. This has a slow onset.
Once you cross the age of 30, there will be a slow decline in testosterone by approximately 1% each passing year. This means that the testes do not completely stop producing testosterone. However, as a result of diabetes and other factors mentioned below, there could be minute changes in the function of the testes between 45 to 50 yrs.
- Age is the most common cause of andropause
- Surgical removal of testes
- Diabetes and other systemic illness
- Long term alcoholism
Symptoms of andropause
- Low sex drive
- Erectile dysfunction
- No morning penile erection
- Lack of energy
- Hot flushes
- Muscle mass reduction
- Reduced ability in concentrating
- Excessive sweating
- Disturbance in sleep patterns
- Thinning of skin
- Dryness of skin
- Mood swings and Irritability
Signs and symptoms of andropause can differ from person to person.
Men who go through andropause have an increased risk of developing certain complications like osteoporosis and cardiovascular problems.
Reported prevalence is 3.1–7.0% in men aged 30–69 years, and 18.4% in men older than 70 years and prevalence of symptomatic androgen deficiency in men 30–79 years of age is 5.6% and it increases with age.
It is based on presence of symptoms suggestive of testosterone deficiency – like reduced interest in sex, erectile dysfunction and blood test showing low testosterone levels. Before initiating therapy benefits and risk should be discussed with patients and in case of poor response, alternative cause should be investigated.
Depression, hypothyroidism and use of medications such as corticosteroids, cimetidine, spironolactone, digoxin, opioid analgesics, antidepressants, and antifungal agents should be excluded before making a diagnosis. Similarly, diagnosis should not be made during acute illness which decreases testosterone levels temporarily.
Low testosterone levels in blood test is the diagnosis. Urologist or Andrologist is the doctor who will examine and diagnose this condition.
Treatment and Prevention
Endocrine Society Clinical Guidelines 2010 recommend against offering testosterone therapy to all older men with low testosterone levels. Guidelines suggest that clinicians consider offering testosterone therapy on an individualized basis to older men with low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency, after discussing the uncertainty about the risks and benefits of testosterone therapy.
2.Life style modifications like increasing physical activity and weight loss are strongly recommended in people with obesity, type 2 diabetes and metabolic syndrome.
Andropause is associated with age-related diseases responsible for significant morbidity and mortality among elderly men rendering it a disorder of immense importance to individual and for public health. Treatment with testosterone becomes promising.
The benefits and risks of testosterone therapy must be clearly discussed with the patient. In case of prostrate cancer, testosterone cannot be given. Response to testosterone treatment should be assessed and if there is no improvement of symptoms and signs, treatment should be withdrawn and the patient investigated for other possible causes which are of great importance in elderly male. And lastly, age is not a contraindication to initiate testosterone treatment.
So please contact your andrologist if you have these symptoms.