What is Andropause?
Defined as a Male Menopause or Deficiency in or Low Testosterone, or simply, MANopause.
Whereas Menopause is a condition with proven pathophysiology leading of some woman to undesirable symptoms and bone-loss in aging, Andropause has increasingly been used to describe the “aging” symptoms in men, from the age of 30, with implications of a “state of hormonal deficiency secondary to gonadal failure”.
The only consolation is that unlike menopause, the reduction in testosterone and its symptoms are more gradual.
1. Androgens (male sex-hormones) are secreted by:
a)Leydig cells (Testis) -in form of Testosterone (0.24mmol/day)
b)Adrenal cortex -in form of Androstenedione (0.002mmol/day).
2. Testosterone (main male sex-hormones):
a) Metabolizes to the biologically active Dihydrotestosterone (DHT) by 5-alpha-reductase
b) Aromatizes to the female hormone Estradiol
c) Mainly binds to
i) sex-hormone-binding Globulin(SHBG -traps usable testosterone from blood),
ii) Albumin &
with 2% left Free available for use by body (Biologically Active/Bioavailable – drops significantly between ages 40-70)
d) falls by 10% per 10yrs
e) remains within normal range level in regardless gradual reduction or notable decline
Common SYMPTOMS include: (different inter-individual)
- Decreased Libido
- Erection difficulties or not as strong as usual
- Lack of energy
- Irritability & Mood swings
- Loss of strength or muscle mass
- Increased body fat
- Hot flushes
Above symptoms may also be just due to aging and may not be reversible despite treatment.
Other complications may include cardiovascular problems and osteoporosis.
1. SHBG starts to increase.
2. The *bioavailable(free) testosterone decreases which causes various physical and perhaps mental changes such as Mood Swings or Fatigue as less testosterone is available to stimulate the body tissue.
3. DHT level remains fairly stable.
4. DHEA (Dehydroepiandrosterone- adrenal Androgen at highest concentration in both men & women’s blood) and *DHEAS (metabolite DHEA Sulphate) decreases 3% per year to only 30% of its serum concentration at age 40 by age 70.
5. Pituitary Gonadotropins (follicles stimulating & luteinizing hormones) increase.
6. Prolactin level decreases.
7. Androgen level’s overall fall may be due to:
-Leydig cells’ progressive (not total) decrease
-Sertoli cells’ impaired function
-Testicular Perfusion impairment
As yet, it is unknown how clinically significant the decline of Androgen level is.
8. Serum Testosterone level is still within normal range, therefore Erectile Dysfunction cannot be presaged.
9. Fertility loss is not characteristic (inter-individual variations), but
10. decrease in Sperm count and
11. moderate decrease in Motility.
TREATMENT & RISKS
HRT (Hormone Replacement Therapy) may be a treatment to reduce Andropause effects though Regular Exercise, Good Nutrition and Stress Reduction are important lifestyle changes to be made. Some studies have shown testosterone supplements to increase lean body mass and muscle strength and several studies done to assess the correlation between testosterone levels and cardiovascular disease risks seem to tend to an inverse link.
There is likelihood that Androgen supplementation may lead to Cardiovascular problems and Prostate Cancer though more studies are needed to determine more accurately the risks.
Androgens has been reported to have an atherogenic effect on blood-lipid profiles though there has not been any proper study on supplement treatment. Other side effects may also include :
Prostate Cancer, on the other hand, is known to be stimulated by Androgens. PSA (Prostate-Specific Antigen) is shown in limited studies to have increased in 92% of patients taking Testosterone supplements but even after stopping treatment, not return to normal in 30% of them.