Andropause also known as male androgen deficiency syndrome is the male equivalent of female menopause. It results from diminished levels of testosterone in the body and exhibits a similar symptom complex to female menopause.
Testosterone is a hormone secreted by the ovaries, adrenal glands and testes. It is the primary male sex hormone, responsible for male sexual development and critical in maintaining erectile function, libido, normal energy levels, and mood. Testosterone also controls a wide range of physiological functions throughout the body systems.
When a man is in his thirties, the testosterone level starts to decline slowly and when a man reaches eighty it is only 1/5 of what it was in his youth. In addition to aging, stress plays a role in declining testosterone levels. While the total testosterone level does not drop drastically the free testosterone, which is the biologically active form, does decline significantly with age. Men with increased estrogen levels (due to obesity, a high-fat diet, alcohol consumption, and low levels of serum zinc) along with insulin resistance can further reduce free testosterone levels.
The number of men in the U.S., between the ages of forty-five and seventy years old, is expected to increase from forty-six million in 1990 to eighty-one million by 2020. Currently more than five million men in the United States suffer from the effects of hypogonadism or low testosterone levels.
In men, andropause symptoms appear over a longer period of time due to the gradual decline of testosterone; however, in women menopausal symptoms occur sooner with the decline in estradiol. Andropause symptoms present slowly, with a loss of overall energy, thinning bones and muscles, increased body fat, depression, and impaired sexual function. Testosterone deficiency has also been linked to hypertension, obesity and heart disease. Men, who have a history of heart attacks often have lower levels of testosterone and higher levels of estrogen. A low free testosterone is an independent predictor for the degree of coronary artery disease in men. Also, low free testosterone is a common characteristic in men suffering from heart failure. Testosterone replacement has been shown in the literature to increase cardiac output in some men with congestive heart failure; however, the free testosterone level must be monitored carefully to prevent problems developing from the hormone.
One way for both men and women to help maintain and increase the free testosterone level is by reducing excess body fat through weight-training. Also, lifestyle changes that include avoiding excess alcohol and high-fat diets, high intake of soy products, and caution with drugs that impair liver function, along with stress management helps to raise free testosterone. Testosterone replacement therapy can dramatically augment the benefits of these lifestyle changes. It is very important to avoid over-the-counter agents promising to improve testosterone levels, such as androstenedione. Also, over the counter testerosterone products are not effective and can raise liver function tests.
In general, when testosterone is replaced for andropausal men it has the potential to prolong the quality-of-life by decreasing the diseases of aging. Testosterone does protect against cardiovascular disease; it can raise HDL cholesterol, and lower LDL cholesterol levels. It may decrease blood pressure, excess body fat, and symptoms of arthritis. Testosterone replacement stimulates the cardiovascular system, the neurologic system, muscles, and bones. It may protect against Alzheimer’s dementia, type II diabetes, osteoporosis, muscle wasting, loss of libido, erectile dysfunction, inflammatory-related diseases and a range of cardiovascular diseases.
Testosterone replacement consists of a twice daily application with a weight-dosed testosterone cream or by injection every two weeks. I generally, do not use the injection due to the peaks and valleys since it is a two week drug. Also, it does not allow the the cholesterol benefits for cardiac protection and lastly due to the esther it has stimulatory effect on the renin-aldosterone system in the kidney producing more water retention which can be a problem in cardiac patients. Testosterone cream is very effective and gives a consistent free testosterone level if the cream is appropriately applied twice a day. Serum levels are checked frequently for hormone optimization with symptom improvement.
