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Andropause is the controversial name given to the phenomenon of declining testosterone levels in aging men. The controversy arises from its comparison to the ‘menopause’ in women, as men can still be fertile despite low testosterone., and not the undisputed physiological changes ‘Andropause’ has many related names including PADAM/ADAM (Partial Androgen Deficiency of the Aging Male.)

To recap, testosterone is the hormone responsible for masculine puberty and continuing sperm maturation. However, from the 20’s peak, testosterone levels gradually decline after age 30. By age 40 up to 10-30% of men are deficient and this percentage continues to rise with advancing age.

The most notable symptoms of a drop in testosterone relate to sex, such as reduced appetite (libido), reduced erections (particularly morning) and reduced enjoyment from sex. This is because these symptoms are more sensitive to a fall in testosterone levels. The other notable symptom is a decrease in mood resulting from a combination of decreased energy level, concentration and memory. Larger drops in testosterone result in reduced lean muscle mass and the unfavourable body shape associated with older men.

Currently, testosterone deficiency is diagnosed through the presence of these symptoms alongside a blood level hormone check. Those with very low levels or whose life is significantly affected by the symptoms are likely to be considered for testosterone replacement treatment.

However, a true diagnosis of ‘andropause’ is not that simple because of many unanswered questions, including what the ‘normal’ level for that individual previously was, if the ‘normal’ levels from the blood test (which is an average of a population sample) can apply, how much of the testosterone measured is reaching the tissues and what real significance does a decrease have for that individual.

Unfortunately, there are also many unanswered questions about treatment- including which for of testosterone replacement best suits and individual and how the body of the individual patient processes it.

Moreover, there are also questions about long term- safety as testosterone replacement, in either form of injection or gel, has been implicated in raising the prostate-specific antigen (PSA) level (a marker for prostate cancer) and also in making the blood thicker, potentially increasing heart attack risk.

Unfortunately there are no satisfactory long-term placebo-controlled trials on this issue and notably a clinical trial was stopped over these very concerns. Subsequent legislation has led to testosterone replacement becoming more restricted- infact, the FDA as of March 2015 requires testosterone products to carry a label to inform about the possible increased risk of heart attack and stroke.

Therefore, it is important to have an honest consultation with your doctor. Even if testosterone replacement is unsuitable, simple interventions available to everyone that may safely increase your testosterone levels to some degree are Vitamin D and Zinc supplementation along with short intense bursts of exercise around 20 minutes duration.

© Syed Z Arfeen
Medical Advisor
December 2015

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