Andropause can be defined as the psychological and physiological symptoms that appear in older men when testosterone decreases. The age of men affected by andropause is around 45 to 65 years.
What is andropause?
Andropause, from the Greek "andros", which means "man" and "pausis", which means "cessation", is often presented as the male counterpart of menopause.
These symptoms range from decreased sexual appetite to erectile problems to a feeling of lack of energy and lethargy. Periods of excessive sweating, insomnia, and weight gain can also increase the impact of decreased production of sex hormones.
Considered a dysfunction by some, as a reflection of normal aging by others, andropause remains a controversial topic. Also, the only drug available, testosterone, has not been tested, either in terms of efficacy or safety.
Menopause for some and andropause for others?
The comparison between andropause and menopause is quite scant. Andropause only affects a minority of men. Furthermore, it does not mark the cessation of fertility. Even the hormonal decline in men is partial, progressive and inconsistent, unlike in women, in whom hormones drop dramatically in a short period of time.
In men, a slight drop in testosterone production would begin in their thirties or forties. From what experts have observed, the concentration of testosterone in the blood would decrease by approximately 1% per year.
How many shoulders are affected by andropause?
Since andropause is poorly understood and rarely detected, precise data are not available on the proportion of men who suffer from it.
However, according to a large study, the European Study on Aging Male, only 2% of men between the ages of 40 and 80 live with andropause - the proportion is 3% among those aged 60 to 69 years and 5% in men aged 70 to 79 years.
Diagnosis was based on the presence of andropausal symptoms and blood testosterone levels below normal.
According to the study authors, these results indicate that testosterone treatment is suitable for very few men. Most of the time, based on their observations, the symptoms are more related to aging, obesity, or another health problem. In fact, 20% to 40% of men would develop symptoms that can resemble those of andropause as they age.
Is it really about testosterone?
Testosterone has been available as a treatment for andropause for just over a decade. The goal of treatment is to improve quality of life by relieving symptoms. Meanwhile, drug companies argue that testosterone could also slow down the aging process: less muscle loss and risk of fractures, more sexual vigor, including better erections, etc. These effects, however, have not been scientifically proven.
These are the main factors that make the treatment of andropause a delicate and complex subject:
1. The level of testosterone that reflects a "deficiency" in middle-aged men is unknown. Also, this rate varies from man to man. The scales currently used have a high degree of inaccuracy and are based on averages for young men;
2. There are no specific symptoms of andropause. In other words, all the symptoms that are experienced may be the result of other health problems, such as depression, vascular problems, or obesity;
3. The association between low testosterone levels and andropause symptoms is low, according to various studies. Men with normal testosterone levels can experience andropause symptoms. Some experts believe that the symptoms of andropause are most often the result of poor lifestyle habits;
4. The benefits and risks of testosterone treatment are not clearly established by short- and long-term clinical trials. Some experts claim that testosterone hormone therapy is an expensive placebo. The main fear of this treatment in older men is increasing the risk of prostate canceror stroke. In fact, testosterone increases the level of hemoglobin and can slightly change the lipid profile in the blood, increasing the risk of a clot forming in an artery in the brain. Other risks mentioned are liver damage, breast development (which can become painful), testicular atrophy, increased aggressive or antisocial behavior, and worsening of an existing health condition (sleep apnea, mania, depression, etc.). Like the hormones prescribed for postmenopausal women, this testosterone treatment may be found later to present some health risks. Studies are ongoing;
5. Other hormonal changes may explain the effects of andropause. DHEA (dehydroepiandrosterone), growth hormone, melatonin and, to a lesser extent, thyroid hormones also exert their influence.
Andropause symptoms
In some men, various symptoms could be explained by a decrease in testosterone production. For now, the ones that seem to be most clearly related to testosterone levels are the following symptoms:
· A decrease in sex drive;
· Less frequent morning erections;
· The inability to have an erection and maintain it properly during intercourse.
Other symptoms often associated with andropause:
· Hot;
· A significant decrease in energy and fatigue;
· A vague depression;
· Insomnia;
· Mild problems with memory and concentration;
· General physical discomfort, lack of physical strength.
· An increase in visceral (abdominal) fat.
Diagnosis of andropause
Since the treatment of andropause is recent, the criteria leading to the diagnosis are not based on a solid scientific basis.
The doctor first asks about the symptoms experienced by his patient. Some assessment forms can be used to better describe the intensity of symptoms, such as the Aging Male Score (AMS) or the Aging Male Androgen Deficiency Test (ADAM).
This is a good opportunity to establish a complete health check: blood tests (lipid profile, thyroid hormones, prostate specific antigen, etc.), a portrait of cardiovascular health, an overview of lifestyle habits. A list of medicines and natural health products consumed will complete everything. This evaluation will help to rule out other possible causes of the symptoms experienced (anemia, depression, hypothyroidism, chronic fatigue syndrome, blood circulation problems, adverse effects of medications, etc.).
Blood tests
Here are some explanations on the tests used to evaluate for a testosterone deficiency.
According to the International Society for the Study of Aging Male (ISSAM), tests to measure testosterone blood levels should be part of the diagnosis, as symptoms may not be related to andropause. But these tests are done only if more than one symptom is present.
· The total level of testosterone. The result of this test includes both carrier-bound testosterone (sex hormone binding globulin or SHBG and, to a lesser extent, albumin) and free circulating testosterone in the blood;
· The level of free testosterone. This is important because it is the free testosterone that is active in the body. On average, about 2% of testosterone circulates freely in the blood. There is no test that directly measures free testosterone levels. Then doctors make an estimate by calculation: They measure the level of sex hormone transporting globulin (SHBG) in the blood and then subtract it from the total testosterone level.
Risk factors
We still know too little about andropause to determine whether some men are at higher risk, however these factors have been associated with a lower testosterone level:
· Excessive alcohol consumption;
· Overweight: An increase of 4 or 5 points in the body mass index would be equivalent to an aging of 10 years in relation to the decrease in testosterone;
· Abdominal obesity Corresponds to a waist circumference greater than 94 cm (37 inches) in humans;
· Diabetes and metabolic syndrome;
· Levels of lipids in the blood, especially cholesterol, outside normal values;
· Chronic disease;
· Liver problems;
· Chronic stress;
· Taking certain medications, such as antipsychotics, some antiepileptics, and narcotics.
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