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.
Posts
