Over the years, the testes gradually reduce the production of testosterone which can trigger in what is medically known as testosterone deficiency syndrome. As a result, a loss of libido (sexual desire) and erectile dysfunction can occur.
Andropause is defined as the set of physiological and psychological symptoms that can accompany the decline of testosterone in aging men . It would usually occur around age 45 at age 65 .
Andropause vs Menopause
The comparison is lame. Andropause only affects a very low percentage of men. in addition, it doesn’t lead to infertility. The hormonal decline in men is partial , progressive and inconstant , unlike the woman, in whom the hormones fall over a short period of time. In men, a slight drop in testosterone production would begin in their thirties or forties. From what the experts have observed, the testosterone concentration in the blood would decrease by about 1% per year.
In women, the arrival of menopause marks the end of their reproductive stage. It appears when the ovaries reduce their production of female sex hormones, estrogen and progesterone, to finally stop releasing ovules that can be fertilized. This loss of fertility in women occurs more or less suddenly, around the age of 50 years old, and has immediate manifestations.
Men, on the other hand, do not experience a process equivalent to Menopause. Even so, this does not mean that your reproductive system does not age , but usually does so in a more gradual way.
Unlike Menopause, in which a deficiency of estrogen is complete and causes clinical changes known as osteoporosis, vaginal dryness, loss of skin elasticity, etc., the decrease in testosterone in elderly men is modest and possible consequences have not yet been well established.
Andropause vs Hypogonadism
Hypogonadism can be caused by genetic disorders, malformations of the testicles or the pituitary gland (gland in the central nervous system that controls the production of hormones in the body), infections such as mumps , testicular trauma, use of drugs or medicines.
When Hypogonadism occurs in the fetus, genital malformations occur. When it arises in pre-adolescence, the patient does not develop typical signs of male puberty, such as body hair, change of voice, increase in muscle mass, increase of the testicles and penis, etc. In young adults, hypogonadism causes infertility, decreased libido, hair loss, muscle atrophy and other symptoms of testosterone deficiency.
In this post, we will stick to the Hypogonadism that comes with aging, called late male hypogonadism or andropause. The Hypogonadism of the elderly is completely different from what occurs in younger men.
Symptoms of Andropause
The function of the testicles and the production of testosterone decreases gradually with age by about 1.3% per year after 40 years. A significant proportion of men over the age of 50 have testosterone levels low enough to diagnose Andropause. It is good to note that a slight testosterone deficiency in middle-aged men can be considered a natural phenomenon of aging. The question is when this deficiency becomes clinically relevant.
Unlike hypogonadism in infants, children and young adults, the decrease in testosterone in older men does not produce really clear consequences. However, although there is no clear evidence, Andropause is currently attributed to some consequences of aging in males, including:
- Reduced libido
- Erectile Dysfunction
- Osteoporosis – Loss of bone mass
- Reduction of muscle mass and strength
- Increase in the percentage of body fat
- Humor changes
- Changes in memory
- Fall of performance in the work
The problem is that not all the changes described above improve with testosterone supplementation and many of them can also occur in the elderly without criteria of Andropause
These factors have been associated with a lower testosterone level :
- Excessive consumption of alcohol and marijuana;
- Overweight as an increase of 4 or 5 points of body mass index would be equivalent to a 10-year aging relative to the decrease of testosterone
- Abdominal obesity. It corresponds to a waist circumference greater than 94 cm (37 inches) in humans;
- Diabetes and metabolic syndrome
- Levels of blood lipids, especially cholesterol, outside normal values
- Chronic disease
- Liver problems
- Chronic stress
- Taking certain medications, such as antipsychotics, antiepileptics and narcotics
Treatment of Andropause
Improvement of lifestyle habits such as;
- Decrease the consumption of tobacco and alcohol.
- Regular physical activity
- Psychological support
Hormone Therapy with Testosterone
Clinics specialized in Andropause have been increased in recent years all over the world. However, if erectile dysfunction is the main symptom, taking an Erectile dysfunction phosphodiesterase type 5 inhibitor ( such as Viagra®, Levitra®, Cialis®) is often considered first. Depending on the case, a consultation with a psychologist or a sexologist can be beneficial.
If Andropause is diagnosed, hormone therapy with testosterone is sometimes prescribed by patch, orally, subcutaneously, intramuscularly. This is the only available medical treatment currently.
According to what doctors observe in clinics, some men would benefit from this treatment. Indeed, hormone therapy with testosterone could increase libido , improve the quality of erections, increase the level of energy and strengthen the muscles . It could also contribute to a better bone mineral density . It may take 4 to 6 months before the therapeutic effects of testosterone are manifested fully.
It is not clear, whether hormone therapy with testosterone poses long-term health risks. Studies are in progress.
Although there are scientific data which suggests that the decrease of testosterone with age can have several negative consequences, the impact of testosterone replacement in older men remains unknown.
What is currently accepted is that testosterone replacement may be beneficial in selected patients. The international endocrinology societies currently indicate testosterone hormonal therapy in elderly patients with low testosterone levels – less than 200 ng / dL measured on at least two or three different opportunities during the morning period – and important symptoms of the Testosterone deficiency. Testosterone is not indicated for elderly people with vague and nonspecific symptoms.
Modes of administration
- The transdermal gel. The gel (Androgel®, 2% concentrate and Testim®, 1% concentrate) is the product most often chosen because it is used quite easily while providing a more stable testosterone level than tablets and injections. It is applied daily to the lower abdomen, upper arms or shoulders, on clean, dry skin for maximum absorption (after the morning shower, for example). We must then wait 5 to 6 hours before wetting the skin, the time that the drug is absorbed. Caution, the medication can however be transmitted to the partner by skin contact.
- Transdermal patches. The patches also allow a very good absorption of the drug. On the other hand, they cause irritation of the skin for half of the people who try it, which explains why they are used less than the gel 14 . A patch should be applied once daily to the trunk, belly or thighs, every evening, varying the sites from one time to the next (Androderm®, 4.8 mg per day);
- Tablets (capsules). Tablets are more rarely used because they are less convenient to use: they must be taken a few times a day. In addition, they have the defect of providing a variable rate of testosterone. For example, testosterone undecanoate (Andriol®, 120 mg to 160 mg daily). Some forms of testosterone tablets present a risk of liver toxicity;
- Intramuscular injections. This is the first mode of administration to enter the market. It remains the least expensive, but requires travel to the doctor or clinic to receive the injection. For example, cypionate (Depo-Testosterone®, 250 mg dose) and testosterone enanthate (Delatestryl®, 250 mg dose) should be injected every 3 weeks. Some people can now do the injections themselves.
Since there is little evidence that testosterone replacement in male hypogonadism delayed brings real benefits without risk of significant adverse effects, treatment should only be done by experts and under close supervision.
The risks of testosterone replacement, the most feared is the increased incidence of prostate cancer . There are no scientists to test the safety of testosterone replacement in relation to prostate cancer studies and therefore the long – term replacement is indicated. The evaluation of the prostate digital rectal examination and measurement of blood PSA are important before planning hormonal treatment.
Can a man prevent Andropause in advance ?
To a certain extent, the impact of symptoms could be mitigated by adopting a healthy lifestyle , since it influences testosterone levels.
For example, to maintain or help restore good erectile function, nutritionist Hélène Baribeau makes the following suggestions:
- Moderate alcohol consumption
- Reduce the consumption of salty foods
- Consume more omega-3s (salmon, sardines, linseeds, etc.)
- Wat more dietary fiber
- Avoid very sweet foods
It would be really nice to have a “treatment” to lessen the signs and symptoms of normal aging . It would be nice if I could take a product that would improve my muscle mass and my performance. Many athletes do it and it seems to work! On the other hand, the price to be paid is a whole series of known and unknown short, medium and long term disadvantages.
It is likely that a very small proportion of middle-aged men actually suffer from andropause and that testosterone treatment is helpful. I believe that for the moment, caution is required. We have not found the fountain of youth yet.
For the time being, there is not enough scientific data on this subject. It will take a lot of additional research on the long-term effects of using testosterone against andropause. When this research is completed, we will really know the pros and cons of this treatment. Only then will men be able to make an informed decision.
A careful follow-up by a caring and knowledgeable physician on the subject seems to me crucial for anyone who uses a testosterone supplement.