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While not as severe as menopause, the male version is lengthier, usually lasting 15 to 20 years. About 40% of men in their 40s, 50s and 60s experience some degree of lethargy, depression, increased irritability, mood swings, and difficulty in attaining and sustaining erections that characterize andropause.
The concept of a male andropause has been more controversial than that of the female menopause, with many arguing that it doesn’t exist. Part of the reason for the controversy is that, in contrast to women, men do not have a clear-cut external sign, namely the cessation of menstruation. A man often begins to experience changes in his body somewhere between the ages of 40 and 55. These bodily changes may be accompanied by changes in attitudes and moods. The aging process alone can not be responsible for this problem as well over 40% of males remain sexually active at 70 years of age and beyond.
Acute andropause in men is relatively uncommon, compared to acute menopause in women, because testicular function declines gradually in most men. There are a number of other causes, however, for acute testicular failure in adult men and these include: viral infections such as mumps, surgical removal of or surgical injury to the testes and male reproductive tract, diseases when the immune system attacks and destroys the testes such as variations of systemic lupus erythematosis, subtle genetic abnormalities which permit normal adult development but lead to premature testicular failure, generalized vascular diseases such as diabetes, chemotherapy, and pituitary tumors (rare).
The second form of this syndrome, while more common, is more insidious since it occurs gradually. It is often confused with male midlife psychological adjustment disorders because it exactly mimics depression in midlife men. Some known contributors to this condition are excessive alcohol consumption, smoking, hypertension, prescription and non-prescription medications, poor diet, lack of exercise, poor circulation, and psychological problems.
Male hormones decline gradually. Testosterone (from the testes), human growth hormone (from the pituitary), and DHEA and androstenedione (from the adrenal gland) levels all begin to drop. For many men this does not occur until their 60s or 70s but there are others where it occurs much earlier. In addition, there are proteins in the blood which bind testosterone into a biologically inactive form - sex hormone binding proteins or globulins. Their levels can rise in response to many conditions including medical disorders and exposure to other hormones such as phytoestrogens (estrogens derived from plant sources such as soy) and environmental estrogen-like compounds (pesticides, hormones used in agribusiness to produce fatter animals, etc.) As an example, there is some data suggesting that men on low fat or vegetarian diets have lower testosterone levels. The overall effect of rising sex hormone binding proteins is that there is less bio-available testosterone.
The diagnosis is simple - measuring either free testosterone blood levels or computing the Free Androgen Index (FAI) which is [total testosterone x 100 / sex hormone binding globulin]. There is some controversy as to what level of total blood testosterone in men is normal with low end values ranging from 250-400ng/dl. Free testosterone in men should be well within the range of 300-1100ng/dl with the FAI between 70-100%. At a FAI of less than 50%, symptoms of andropause appear.
Risks of replacement therapy
Though often suggested, there is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer. Men using synthetic testosterone supplementation should have their serum lipids carefully evaluated and rechecked periodically. Using a natural testosterone is safer than using a synthetic form, but may require the transdermal route of administration.
As a general principle, whenever any hormone is administered, the gland which normally produces it ceases to function and recovery when therapy stops can be variable. Patients with borderline low testosterone levels may be committing themselves to lifelong therapy if they start with testosterone replacement.
Benefits of replacement therapy
There is no doubt that the administration of testosterone to men with true testosterone deficiency will improve their health and sense of well being. The symptoms listed above should disappear. Unfortunately impotence, or the inability to sustain and erection, does not respond well to testosterone therapy except perhaps in men with severe hormone deficiencies. This comprises approximately 8-16% of men presenting themselves to physicians with erectile disorders. There is no evidence that administering testosterone to men with borderline low testosterone levels will improve sexual functioning, although libido may be enhanced.
For more insight, The Testosterone Syndrome, by Eugene Shippen, M.D. and William Fryer, provides a persuasive argument in favor of hormone modulation in the male andropause.
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Acute: An illness or symptom of sudden onset, which generally has a short duration.
Androgen: Any steroid hormone that increases male characteristics.
Cancer: Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chemotherapy: A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.
DHEA: Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diabetes Mellitus: A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Estrogen: One of the female sex hormones produced by the ovaries.
Hormones: Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypertension: High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Immune System: A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Insidious: A symptom or condition of gradual onset or development.
Lipid: Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Menopause: The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
ng: Nanogram: 0.000000001 or a billionth of a gram.
Pituitary: The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.
Prostate: The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.
Protein: Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Serum: The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Testosterone: The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.