Sunday, May 24, 2015

MEN-O-PAUSE: The Andropause, the male menopuase.


Menopause in females is a well delineated and abrupt of decline of estrogenic hormones, and reproductive function, somatic and psychological functions.

Whereas ANDROPAUSE in males is a controversial concept: not widely accepted.

In males andropause there is a gradual decline of functioning. As described by Morales and Lunenfeld (International Society for the Study of the Aging Male) it’s a “biochemical syndrome associated with advancing age and characterized by a deficiency in serum androgen levels with or without a decreased genomic sensitivity to androgens”

The decline in testosterone with aging is related to decreases in both hypothalamic (HPA axis less sensitive, less GNRH-less LH) and testicular function (Leydig cells decrease)

There is a   lack of established normal testosterone levels for different age groups (Approx 1-2% decline from 40-70yrs)

For now it’s a diagnosis of exclusion after ruling out other causes of gonadal dysfunction like medication side effects, thyroid problems, depression and excessive alcohol use, obstructive sleep apnea.

Diagnosis is based on the psychological and cognitive hints of andropause including loss of cognitive function, depression, and “loss of drive”, chronic fatigue, lethargy, hot flashes, ED, decrease libido,  ?midlife/latelife crisis. On Physical Examination there decrease in lean body mass(l ess muscles and more fat) and changes in hair, skin, and fat distribution, osteopenia and osteoporosis.
Plus a low testosterone level (a concomitant raised LH indicates testicular deficiency)

Testosterone replacement Therapy(TRT) in this population is anabolic,  including increase in lean body mass and associated decrease in fat mass, increased bone mineral density, increase in muscle strength and sexual function, improved generalized feelings of well-being, and improved cognitive function

Side effects of TRT being Promotion of fluid retention, Increase in cardiovascular disease risk, Precipitation or worsening of sleep apnea, Gynecomastia, Polycythemia, Fluctuations in mood, Worsening of pre-existing prostatic disease(possibly does not induce)

There is absence of long-term placebo-controlled trials of TRT.

A few points of cation: Andropause is not a widely accepted construct, is not universal as female menopause. There is lack of age appropriate standardized values of serum testosterone. When its there, its very gradual in onset and difficult to detect.

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