Definition of Andropause
Andropause is defined as the set of physiological and psychological symptoms that can accompany the decline of testosterone in the aging man. It usually occurs at around 45 years of age at age 65.
Andropause, from the Greek Andros, which means “man,” and pauses, “cessation,” is often presented as the masculine counterpart of menopause.
These symptoms range from decreased sexual appetite to erectile problems to a feeling of being short of energy and enthusiasm. Periods of excessive sweating, insomnia and weight gain may also be added to the impact of declining sex hormone production.
Considered as a dysfunction by some, as a reflection of normal aging by others, andropause remains a controversial subject. What is more, the only drug offered, testosterone has not been proven, either in terms of efficacy or safety.
Menopause for some, andropause for others?
The comparison between andropause and menopause is rather lame. Andropause affects only a minority of men. Also, it does not mark the cessation of fertility. Moreover, the hormonal decline in man is partial, progressive and inconstant, unlike the woman, in whom the hormones fall markedly over a short period of time. In men, a slight decline in testosterone production would begin in their thirties or forties. According to experts, the testosterone concentration in the blood would decrease by about 1% per year.
How many men are affected?
Since andropause is little known and rarely detected, accurate data are not available on the proportion of men who suffer from it.
However, according to a large study published in 2010, the European Male Aging Study, only 2% of men aged 40 to 80 years experience an andropause: the proportion is 3% in the 60 years to 69 years and 5% among 70 to 79 years 1. The diagnosis was based on the presence of symptoms of andropause and lower than normal blood testosterone levels.
According to the study authors, these results indicate that testosterone treatment is suitable for very few men 12. Most of the time, according to their observations, the symptoms are rather related to aging, obesity or another health problem. Indeed, 20% to 40% of men would develop symptoms may resemble those of andropause with age 11.
Really a question of testosterone?
The testosterone is available as a treatment for the andropause for a little over a decade. The goal of treatment is to improve quality of life by alleviating symptoms. Pharmaceutical companies maintain that testosterone could also delay the aging process: less loss of muscle mass and risk of fractures, more sexual energy, including better erections, and so on. However, these effects have not been demonstrated scientifically.
Here are the main factors that make the treatment of andropause a delicate and complex subject:
The testosterone level that reflects “insufficiency” in middle-aged men is unknown. Moreover, this rate varies from man to man. The scales currently used have a high degree of vagueness and are based on established averages in young men;
There are no symptoms of andropause. In other words, all the symptoms felt can be the result of other health problems, such as depression, vascular problems or obesity;
The association between a low testosterone level and the symptoms of andropause is low, according to various studies. Men with normal testosterone levels may experience symptoms of andropause. Some experts believe that the symptoms of andropause are more often the result of bad habits life 2, 11;
The benefits and risks of treatment with testosterone are not clearly established in clinical trials, both short and long term. Some experts claim that hormone therapy with testosterone is an expensive placebo 12. The main fear associated with this treatment in older men is to increase the risk of prostate cancer or stroke. Indeed, testosterone increases the hemoglobin level and can slightly alter the lipid profile in the blood, increasing the risk that a blood clot will form in an artery of the brain. Other risks include liver damage, breast development (which can become painful), testicular atrophy, increased aggressive or antisocial behavior, and aggravation of an existing health problem (sleep apnea, mania, depression, etc.). Like the hormones prescribed for postmenopausal women, it may be discovered a posteriori that this treatment with testosterone presents certain health risks. Studies are underway;
Other hormonal changes may explain the effects of andropause. DHEA (dehydroepiandrosterone), growth hormone, melatonin and, to a lesser extent, thyroid hormones also have their influence.
Testosterone is the predominant sexual hormone in humans. It is associated with vitality and virility. It is due to the appearance of male sexual characteristics at puberty. It also helps maintain bone health and muscle firmness and stimulates the production of sperm and red blood cells. The way the fat accumulates on the body is also influenced by this hormone. Women also produce but in very small quantities.
Testes produce testosterone. The amount of testosterone produced depends on signals from glands in the brain: the hypothalamus and the pituitary gland. Various factors will promote or inhibit the production of testosterone. Sex, for example, stimulates it. Once produced, testosterone circulates in the bloodstream and binds to receptors of various tissues, where it exerts its effects.
Since the treatment of andropause is recent, the criteria leading to the diagnosis are not based on a solid scientific basis.
The physician first asks about the symptoms felt by his patient. He may use some assessment forms to better describe the intensity of the symptoms, such as the Aging Male Score (AMS) or the ADAM (Androgen Deficiency of the Aging Male) test. To view these tests, see the Sites of Interest section.
This is a good opportunity to establish a complete health check: blood tests (lipid profile, thyroid hormones, prostate specific antigen, etc.), portrait of cardiovascular health, and overview of lifestyle habits. A list of medicines and natural health products consumed will complete the package. This assessment will help to exclude other possible causes of the symptoms experienced (anemia, depression, hypothyroidism, chronic fatigue syndrome, blood circulation problems, adverse drug effects, etc.).
Here are some explanations about the tests used to assess whether there is a testosterone deficiency.
Testing for blood testosterone levels should be included in the diagnosis as the symptoms may not be related to andropause 3, according to the International Society for the Study of Aging Male (ISSAM). But these tests are performed only if more than one symptom manifests itself.
Total testosterone levels. The result of this test includes both testosterone linked to a carrier (sex hormone binding globulin or SHBG and, to a lesser extent, albumin) and testosterone circulating freely in the blood;
Free testosterone. This measurement is important since 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 the rate of free testosterone. Doctors then calculate the sex hormone binding globulin (SHBG) in the blood and then subtract it from the total testosterone.