Andropause is the term that describes the age at which a significant decline in testosterone reaches a pathogenic threshold. It is also considered male menopause. Normally, after the age of 40, testosterone levels start to decrease in males.
Andropause is a very common condition that affects many males all over the world. Typically, our focus revolves around female conditions such as menopause and PCOD. However, in this article, we will delve into the relatively less recognized condition of andropause, exploring its underlying causes, symptoms, and available treatments.
According to Greek words, “Andras” means human male and “pause” means a cessation, so literally, “andropause” is defined as a syndrome associated with a decline in sexual satisfaction or a decrease in a feeling of general well-being with low levels of testosterone in older men. 1
Andropause is the more common term for male menopause. It can also affect fertility. 2
Fatigue
Erectile dysfunction
Insomnia (lack of sleep)
Mood changes
Low energy
Depression or sadness
Lack of concentration
Reduced muscle mass and physical weakness
Reduced libido
Gynecomastia (development of breasts in men)
Infertility
Hypogonadism: Hypogonadism is the main cause of the clinical symptoms of andropause. 3
Chronic disease or accidents: Andropause also exists in men who lose their testicular function due to diseases or accidents. 3
Injury to the testicles and cancer treatments such as chemotherapy or radiation can negatively affect testosterone production.5
Increasing age: Aging is associated with a number of changes in physiological functions, many of which are regulated by androgens. 4
Stress: Stress can also reduce testosterone production.
Testosterone replacement therapy: In testosterone replacement therapy, if low testosterone is interfering with a person's health and quality of life, then artificial testosterone can be administered orally, through injections, or with gels or skin patches.
Oral: Andriol®; Organon
Parenteral (IM): cypionate or enanthate esters
Transdermal gel: AndroGel®, Testim® 7
Losing weight and being physically active: Exercising can help slow the decrease in testosterone your body is experiencing.
Erectile dysfunction medication
Erectile dysfunction medication may help for symptoms like lower testosterone
Sleeping aids
If you’re unable to get relief from insomnia using relaxation and natural remedies, sleeping medications may help.7
Medbound Times reached out to some experts for their insights on andropause:
Andropause, or male menopause, is a common disorder in men seen in advancing age. Diagnosis is usually based on symptoms like erectile dysfunction, loss of libido, fatigue, irritability, sleep disturbances, hot flashes, and the presence of low testosterone levels. It usually has an insidious onset and is slowly progressive. Testosterone therapy is generally the line of treatment advised to patients, but with caution as the benefits are still not clear and there are potential risks as well.Dr. Sushmita Ganguli, BHMS
Andropause is also known as testosterone deficiency syndrome. Testosterone levels decline with aging at a rate of 1% per year. The rate of decline in testosterone levels varies in different individuals, and it is affected by chronic diseases such as obesity, illness, stressful events, and medications. Various studies have suggested the use of testosterone replacement therapy in such patients but with caution. Prior to the start of testosterone replacement therapy, risk stratification for the development of breast and prostate cancer has to be done.
For patients with obesity and metabolic disorders, lifestyle modifications should be suggested.
In conclusion, andropause holds the risk of osteoporosis, cognitive decline, metabolic dysfunction, and sexual life.
Treatment with testosterone becomes promising. However, the results of clinical trials suggest an incomplete picture of the complex interaction between aging and androgen deficiency.
All the risks and benefits should be discussed with the patient before initiating the therapy.
Creating awareness about andropause is a must, as it deeply impacts the quality of life of elderly males.
- Dr. Tanuj Lawania Rai, MBBS, DNB Obstetrician and Gynecologist
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046605/
https://www.healthline.com/health/menopause/male
https://www.news-medical.net/health/The-Male-Menopause-Exploring-Andropause.aspx
https://academic.oup.com/biomedgerontology/article/57/2/M76/547924
https://www.healthline.com/health/what-is-testosterone#low-t-levels
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921612/
https://www.healthline.com/health/side-effects-of-low-testosterone#treatment
(Author: Jeba Aslam Mulani)