||This article needs more medical references for verification or relies too heavily on primary sources. (June 2016)|
Andropause – also colloquially known as male menopause – is said to be the result of a gradual drop in testosterone, which is an androgen. The medical community is currently debating whether or not men really do go through a well-defined menopause. The condition "andropause" is not recognized by the World Health Organization.
Andropause is caused by the reduction of hormones testosterone and dehydroepiandrosterone in middle-aged men. Testosterone assists the male body in building protein and aids in maintaining sexual drive and stamina. Testosterone also contributes to several metabolic functions including bone formation, and liver function. Andropause is also associated with a decrease in Leydig cells. A steady decline in testosterone levels with age (in both men and women) is well documented.
External factors that can cause testosterone levels to fall include certain forms of medication, poor diet, excessive alcohol consumption, illness, lack of sleep, lack of sex, stress, or surgery. It can also be a symptom of neuroendocrine dysfunction after mild traumatic brain injury.
Andropause is preceded by a condition called Hypogonadotropic hypogonadism. A downturn in the circulation of testosterone can cause the hypothalamus and pituitary gland to trigger a release of brain hormones that stimulate the testicles to ramp up production of testosterone.
Although, as men age, despite low testosterone the levels of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) will not rise. The luteinizing hormone, gonadotropic releasing hormone, and testosterone all are dropping below what is considered normal. Low GnRH, low LH, low testosterone indicate the syndrome of hypogonadotropic hypogonadism, and it is a downward trend that takes men closer to andropause. This phenomenon typically begins in the early forties.
This shift in hormonal patterns occurs in all men at some point. The female version, a similar hormonal shift that occurs in women happens in a more narrow age grouping, from early forties to late fifties.
Testosterone levels decline gradually with age. Unlike females going through menopause, the decline in testosterone in men is gradual, and there is variation among individuals. Upon reaching 80 years of age, the rate of testosterone secretion has decreased about 50% for men.
Researchers conclude there is no black-and-white cutoff for "low" or "suboptimal" testosterone. Different symptoms show up at different testosterone thresholds: Muscle mass and strength do not decline until testosterone drops quite low (significantly below normal levels) whereas libido may dampen with relatively small decreases in the hormone. According to Joel Finkelstein, associate director of the Bone Density Center at Massachusetts General Hospital in Boston, men’s functioning is not impaired solely by a loss of testosterone, but by a loss of estrogen as well.
Agreement on the threshold of testosterone values below which a man would be considered hypogonadal has not been reached. Testosterone can be measured as "free" (that is, bioavailable and unbound) or, more commonly, "total" (including the percentage that is chemically bound and unavailable). In the United States, male total testosterone levels below 300 ng/dl from a morning serum sample (most accurate measurement) are generally considered low. To confirm the low levels of testosterone, doctors recommend repeating the measurement of morning total testosterone.
|This section needs additional citations for verification. (January 2015) (Learn how and when to remove this template message)|
Much of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond, a lay person. According to Diamond's view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, may occur as early as age 45 to 50 and more dramatically after the age of 70 in some men. The term "male menopause" may be a misnomer, as unlike women, men's reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives. But Diamond claims that, in terms of other life impacts, women's and men’s experience are somewhat similar phenomena.
Many clinicians believe that andropause is not a valid concept. Men can continue to reproduce into old age; their reproductive systems do not stop working in midlife, and therefore they do not exhibit the sudden and dramatic drops in hormone levels characteristic of women going through menopause.
Other clinicians have the opinion that andropause is simply synonymous with hypogonadism or unusually low testosterone levels. There is opposition to the concept of andropause in Europe as well as the U.S.
Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition. For example, people who are overweight may be misguided into treating a new illness rather than addressing the lifestyle that led to their being overweight. Similarly, energy levels vary from person to person, and for people who are generally inactive, energy levels will automatically be lower overall.
While it is true that active and otherwise healthy men could in theory develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.
The significance of a decrease in testosterone levels is debated and its treatment with replacement is controversial. The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging. The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.
Adverse effects of testosterone supplementation include increased cardiovascular events (including strokes and heart attacks) and deaths). The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established for low testosterone levels due to aging. The FDA has required that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.
Other significant adverse effects of testosterone supplementation include acceleration of pre-existing prostate cancer growth in individuals who have undergone androgen deprivation; increased hematocrit, which can require venipuncture in order to treat; and, exacerbation of sleep apnea. Adverse effects may also include minor side-effects such as acne and oily skin, as well as, significant hair loss and/or thinning of the hair, which may be prevented with 5-alpha reductase inhibitors ordinarily used for the treatment of benign prostatic hyperplasia, such as finasteride or dutasteride. Exogenous testosterone may also cause suppression of spermatogenesis, leading to, in some cases, infertility. It is recommended that physicians screen for prostate cancer with a digital rectal exam and prostate-specific antigen (PSA) level before starting therapy, and monitor PSA and hematocrit levels closely during therapy.
The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers identified symptoms of what they labeled the "male climacteric" including loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. Heller and Myers found that their subjects had lower than normal levels of testosterone, and that symptoms decreased dramatically when patients were given replacement doses of testosterone.
Society and culture
Some researchers prefer the term "androgen deficiency of the aging male" ("ADAM"), to more accurately reflect the fact that the loss of testosterone production is gradual and asymptotic (in contrast to the more abrupt change associated with menopause.) The "D" is sometimes given as "decline" instead of "deficiency". In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.
- "Male Menopause". Archived from the original on 12 December 2007. Retrieved 2007-12-17.
- Mahmoud A, Comhaire FH (2006). "Mechanisms of disease: late-onset hypogonadism". Nat Clin Pract Urol. 3 (8): 430–8. doi:10.1038/ncpuro0560. PMID 16902519.
- Mooradian AD, Korenman SG (2006). "Management of the cardinal features of andropause". Am J Ther. 13 (2): 145–60. doi:10.1097/01.mjt.0000132252.80403.c9. PMID 16645432.
- "Male Menopause". www.nhs.uk. NHS Choices. Retrieved 15 October 2014.
- "DCoE Clinical Recommendation | August 2012 Indications and Conditions for Neuroendocrine Dysfunction Screening Post Mild Traumatic Brain Injury" (PDF). DCOE Defense Centers of Excellence. Retrieved 2 December 2013.
- "Testosterone Deficiency (Primary Hypogonadism and Secondary/Hypogonadotrophic Hypogonadism)". What is Testosterone Deficiency. Virtual Medical Center.
- Florence Comite (November 21, 2013). "Why You Should Avoid Carbs at Bedtime". Men's Health. Retrieved October 24, 2014.
- "Hormonal Expression of Androgen Decline in Aging Men (ADAM)". Florence Comite. The Endocrine Society.
- Borst, S.E.; Mulligan, T (2007). "Testosterone Replacement Therapy for Older Men". Clinical Interventions in Aging. 4 (2).
- “US National Library of Medicine, National Institutes of Health”, Differential effects on bone of estrogen receptor α and androgen receptor activation in orchidectomized adult male mice, October 22, 2003
- “WebMD”, Testosterone Not the Whole Story in 'Male Menopause', September 11, 2014
- ‘’The Journal of Clinical Endocrinology & Metabolism Blood Testosterone Threshold for Androgen Deficiency Symptoms, July 2, 2013
- Diamond, Jed (1998). Male Menopause. Naperville, Ill: Sourcebooks. ISBN 1-57071-397-9.
- Cetel, Nancy (2002). Double Menopause: What to Do When Both You and Your Mate Have Hormonal Changes Together. New York: Wiley. ISBN 0-471-40262-1.
- Diamond, Jed (2000). Surviving Male Menopause. A Guide for Women and Men. Naperville, Ill: Sourcebooks. ISBN 1-57071-433-9.
- Tan, Robert S. (2001). The andropause mystery: unraveling truths about the male menopause. Houston, Tex: AMRED Pub. ISBN 0-9707061-0-3.
- Juul, A.; Skakkebaek, N. E. (2002). "Testosterone treatment of elderly men. The so called andropause doesn't exist.". Ugeskrift for Læger (in Danish). 164 (42): 4941–2. PMID 12416079.
- Staff (3 March 2015). "Testosterone Products: Drug Safety Communication - FDA Cautions About Using Testosterone Products for Low Testosterone Due to Aging; Requires Labeling Change to Inform of Possible Increased Risk of Heart Attack And Stroke". FDA. Retrieved 5 March 2015.
- Tavernise, Sabrina (March 3, 2015). "Drugs Using Testosterone Will Label Heart Risks". New York Times. Retrieved March 19, 2015.
- Finkle WD, Greenland S, Ridgeway GK, Adams JL, Frasco MA, Cook MB, Fraumeni JF, Hoover RN (January 2014). "Increased Risk of Non-fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men" (PDF). PLoS ONE. 9 (1): e85805. doi:10.1371/journal.pone.0085805. PMC . PMID 24489673.
- Pastuszak, A. W.; Pearlman, A. M.; Lai, W. S.; Godoy, G; Sathyamoorthy, K; Liu, J. S.; Miles, B. J.; Lipshultz, L. I.; Khera, M (2013). "Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy". The Journal of Urology. 190 (2): 639–44. doi:10.1016/j.juro.2013.02.002. PMID 23395803.
- “Therapeutic Advances in Drug Safety”, Adverse effects of testosterone replacement therapy: an update on the evidence and controversy, October 2004
- "Contraceptive efficacy of testosterone-induced azoospermia in normal men. World Health Organization Task Force on methods for the regulation of male fertility". Lancet. 336 (8721): 955–9. October 1990. doi:10.1016/0140-6736(90)92416-F. PMID 1977002.
- “National Academy of Sciences”, Testosterone and Aging: Clinical Research Directions, 2004
- Heller, C.G., Myers, G.B., "The Male climacteric: Its symptomatology, diagnosis and treatment." JAMA 1944; 126:472-77.
- Fuller SJ, Tan RS, Martins RN (2007). "Androgens in the etiology of Alzheimer's disease in aging men and possible therapeutic interventions". J. Alzheimers Dis. 12 (2): 129–42. PMID 17917157.
- "Columbia Presbyterian - Department of Urology". Archived from the original on February 8, 2007. Retrieved 2007-12-17.
- "There's help for "grumpy old men", but they're reluctant to admit to problem, says Queen's urologist". Retrieved 2007-12-17.
- Morales A (2004). "Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies". Aging Male. 7 (4): 297–303. doi:10.1080/13685530400016664. PMID 15799125.
- "What is Hypogonadism". AgeWait.
- Tancredi A, Reginster JY, Luyckx F, Legros JJ (2005). "No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause'". Psychoneuroendocrinology. 30 (7): 638–46. doi:10.1016/j.psyneuen.2005.02.002. PMID 15854780.