Andropause or male menopause is a name that has been given to a set of effects that appears in some aging men, and which have some superficial similarities to menopause effects in women.
- The male menopause (androgen deficiency) is caused by a reduction in active (free) testosterone levels but why this causes such diverse symptoms is not clear.
- Testosterone is made predominantly by the testicles. They are stimulated to produce testosterone by other circulating hormones, which originate from the pituitary gland below the hypothalamus (at the base of the brain).
- Testosterone deficiency is probably due to an imbalance in the hypothalamic-pituitary-testicular axis.
- It is not known why testosterone levels fall with increasing age or why active testosterone deficiency results in such a wide variety of symptoms but low levels of active (free) testosterone may occur if SHBG levels are raised; this can happen in heavy drinkers, in men who smoke more than 10 cigarettes a day and in men with an underactive thyroid gland.
Warning Signs and Symptoms
Symptoms of the male menopause (androgen deficiency) are non-specific and may include:
The common factor which lies behind these symptoms is a reduction in the levels of active testosterone (male hormone) in the blood with increasing age. At the same time, there is an increased risk of heart disease, obesity, high blood pressure and diabetes, all of which can contribute to health problems.
- Alterations in the circulatory & nervous systems (hot flushes, sweating, insomnia & nervousness)
- Changes in mood and mental function (anxiety, irritability, poor sleep, constant tiredness, poor short-term memory & low self-esteem)
- Changes in virility (decreased physical energy, decreased muscle strength & inability to participate in sporting activities)
- Diminished sexual function (reduced sex drive, poor erections & impaired ejaculation)
- Changes in physical appearance (abdominal weight gain - loss of body hair, diminished muscle mass & loss of height)
- Changes in body metabolism & chemistry (increased LDL cholesterol, increased total body fat, osteoporosis & reduction in the red blood cells in the blood)
- Full history concentrating on "lifestyle" factors (stress, physical activity, smoking habits, alcohol consumption & drug consumption).
- Physical examination including rectal examination of the prostate gland and measurement of blood pressure
- General blood tests normally include measurements of kidney, liver, bone & thyroid function, a blood sugar and cholesterol measurement as well as a check on blood cells for anemia and other problems
- Hormone measurements - testosterone levels will be measured (total & free) with sex hormone-binding globulin (SHBG). This will allow the doctor to see how much active (free) testosterone is in the patient’s bloodstream. Follicle cell stimulating hormone (FSH), luteinizing hormone (LH) and prolactin levels, which control testosterone production by the testicles, may also be measured.
- Other specific tests include calculating body mass index (BMI). an ECG or bone density measurement (to look for osteoporosis), PSA especially if over 50, to test for possible prostate cancer; finding cancer would be a contraindication to taking testosterone replacement therapy (TRT)
- Detailed endocrinology assessment to exclude an underlying hormone problem in young men (less than 50) with these type of symptoms
If the patient has significant symptoms and reduced blood levels of active testosterone, testosterone replacement therapy (TRT) should be considered
Side-effects of TRT - Although TRT is unlikely to cause prostate cancer, it may encourage existing cancers to grow more quickly and it does cause enlargement of benign prostate glands (which may result in troublesome symptoms). Regular PSA (prostate-specific antigen) tests and rectal examinations to monitor the prostate gland are essential. Cholesterol and red blood cells levels may also be affected by TRT and should be closely monitored. The patient may notice headaches, weight gain, acne and increased baldness whilst taking TRT. It is important to note that, whilst troublesome symptoms may improve, the long-term benefits of TRT treatment are not known.
- Lifestyle modification by finding new ways to relieve stress, eating a healthy diet, getting plenty of sleep, exercising regularly, limiting intake of alcohol and stopping smoking.
- Testosterone-replacement therapy (TRT) may be given by tablets, injections, gel or patches; most men find the last two more convenient. Blood levels should be monitored regularly to ensure that they are maintained within the normal range.
TRT should not be prescribed if the patient has any of the following conditions:
- known breast or prostate cancer
- PSA level of greater than 3 ng/ml or known nodule in the prostate
- hypervicosity syndromes (thick blood or "sticky" red blood cells)
- high red blood cell count (packed cell volume, PCV, greater than 50%)
- untreated obstructive sleep apnea
- severe prostatic symptoms
- heart failure
Viagra®, Cialis® or Vardenafil®
TRT alone may improve erections but this is not guaranteed. If erectile function remains a problem during TRT treatment, the patient may need to try Viagra (Sildenafil), Cialis (Tadalafil) or Levitra (Vardenafil) as well.