Andropause

Andropause is the term  used to describe the decline in male hormones, called androgens,  that occurs with aging.  Andropause also refers to the collection of symptoms associated with this age-related decline in gonadal function in men.
A recent World Health Organization (WHO) report, states that “male androgens progressively decline with age.” The study tested androgen levels at age 25 and by age 70, androgen levels were only 10 percent of what they were during youth. In contrast to the rapid decline in ovarian function in women at menopause, with andropause men experience a gradual decline in testicular function and testosterone production. It is likely that the decline in testosterone production  primarily occurs in the testes. However, there is some evidence to suggest that the central component (i.e. alterations in the hypothalamic-pituitary-gonadal axis) may also have a role. Stress, illness, medications, obesity, malnutrition and psychiatric conditions, all common in the elderly, tend to reduce testosterone production. However, decreased plasma testosterone levels are also found in healthy elderly individuals.
The reduced testosterone production in men results in diminished muscular strength, energy and libido, erectile dysfunction, depression, and osteoporosis and related fractures.
To manage these conditions of aging, the value of testosterone replacement is often employed. However, the benefits and risks of testosterone therapy need to be evaluated on a case by case basis. Routine treatment of elderly individuals with testosterone replacement therapy cannot be recommended for every man. Future development of drugs that will target the testosterone receptor called, selective androgen receptor modulators, may provide beneficial effects without the adverse ones.

Andropause is associated with low (bioavailable) testosterone levels. Every man experiences a progressive decline in  testosterone but some men’s decline is more rapid than others than others. And when this happens these men can experience andropausal symptoms.

These symptoms can impact their quality of life and may expose them to other, longer-term risks of low-testosterone. It is estimated that 30 percent of men in their 50s will have testosterone levels low enough to be causing symptoms or putting them at risk.

The Effect of Low Testosterone

When there is less testosterone available to do its work, the testosterone target-organ response decreases, bringing about many changes.

There is great variability in testosterone levels among healthy men so not all will experience the same changes to the same extent. But typical responses to low  testosterone levels include:

  • Decreased sex drive
  • Emotional, psychological and behavioral changes
  • Decreased muscle mass
  • Loss of muscle strength
  • Increased upper and central body fat
  • Osteoporosis or weak bones and back pain
  • Cardiovascular risk


In addition to quality of life measures, there are other longer-term effects of decreased testosterone that might include an increased cardiovascular risk and osteoporosis.

Osteoporosis
In healthy men, bone tissue is constantly being broken down and rebuilt. In an individual with osteoporosis, more bone tissue is lost than is regenerated.  In men, testosterone is thought to play a role in helping to maintain this balance. Between the ages of 40 and 70 years, male bone density falls by up to 15 percent.

Low bone density puts a man at risk of frequent fractures, associated pain, and in many cases, loss of independence. Wrists, hips, spine and ribs are most commonly affected.

Cardiovascular risk
Recent evidence suggests that atherosclerosis (hardening of the arteries) occurs in men as their testosterone levels diminish with age. While research is not as complete as for women, the clinical findings point to an association between low-testosterone levels and an increase in cardiovascular risk factors in men.

How do I know I may have a low testosterone?

The following observations  might indicate a low testosterone.

1. A decrease in strength and/or endurance.

2. A lack of energy.

3. A decrease in your sex drive (libido).

4. Being sadder and/or grumpier than usual.

5. Having a loss of height.

6. Have you noticed a decreased enjoyment in life.

7. A recent deterioration in your ability to play sports.

8. A recent deterioration in your work performance.

9. Decreased strength of erections .

10. Falling asleep after dinner.
If you would like more information or would like to make an appointment, please contact:

Bruce R.Gilbert, M.D., Ph.D. at 516-487-2700 or bgilbert@gmail.com