ANDROPAUSE

Andropause is a biochemical syndrome accompanied by a series of symptoms associated with ageing and a decline in serum testosterone (T) levels. Andropause has many synonyms such as male menopause, male climacteric, androgen deficiency of the ageing male, and partial androgen deficiency of the ageing male. Andropause causes harmful effects on many organ systems (muscles, bones, consciousness, and glycaemic control), as well as affecting men’s quality of life. Testosterone production in the ageing male gradually decreases. 

Male T levels decrease by 10% per decade after the age of 30. Men over the age of 50 lose 25% of male T levels. After the age of 70, there is 50% of male T levels.  

How does it affect the quality of life? 

Not feeling energetic as used to be, decrease in intellectual activities, muscle mass, and resistance, lack of desire for sex, erectile dysfunction, increased belly fat, decline in bone mineral density, sleep disorders, reduction in body hair, skin changes, depressed mood, poor glycaemic control, high insulin resistance, and increased risk of metabolic syndrome are the main symptoms affecting the quality of life.   

What is the role of androgen hormone in sexuality? 

Normally, T hormone has a role in sexual desire (libido), rather than in the penile tissue. The main symptom about sexuality is the loss of libido. Besides, it indirectly causes loss of erection. Generally accepted low T level is 200 ng/dl or below. Low T level and the presence of the symptoms are enough for diagnosis. Although prostate cancer is not a contraindication to the T replacement, rectal examination and PSA follow-up are essential before the replacement. 

Which medications are used for andropause treatment?

The aim the andropause treatment is to replace the low T. Replacement can be done orally, intramuscularly, or subcutaneously. The method can be determined by the patient or upon physician’s preference. Short-acting form applied on the skin should be preferred, because it captures the circadian rhythm of T. Today, the most accepted methods are the forms applied on the skin (gel, patch). This treatment method should be avoided in the presence of breast cancer in men. 

What are the success rates of medication?

Increase in quality of life, restoration of sexual life, overall well-being, improvement in glycaemic control, and a decline in cardiovascular risk are expected after accurate diagnosis and T replacement. 

Does excessive testosterone have benefits?

No; quite the contrary, it may be harmful. T replacement therapy should only be given to men with low T levels.