The term Andropause is used to parallel the female menopause. These two entities are different in their physiology, evolution, prognosis and clinical effects.
It should be noted that androgen deficiency is gradual, occurs in 25 to 35% of men and there is only a partial androgen deficiency, not significantly affecting their ability to fertilize in certain cases, which is totally opposite to the menopausal stage.
The onset of andropause is unpredictable and its manifestations are subtle and diverse. There are two synonymous terms that can be used as a definition of the phenomenon:
- A.D.A.M. (Androgen Deficiency Adult Male).
- L.O.H. (Late onset hypogonadism).
Thus, we refer to Andropause without this being a correct term, just as when we refer to athlete’s foot. When describing the symptoms and signs of late hypogonadism, many people identify with them, which explains their unspecificity, and they can be caused by multiple factors (stress, hypothyroidism, sedentary life, sexual dysfunction…) or simply by a physiological phenomenon linked to age.
When does Andropause begin?
The term “Andropause”, as we have already pointed out, is not a male equivalent of menopause, but we use it in a figurative sense to refer to Adult Surviving Testosterone Deficiency. It should be mentioned that, in men, there is no definitive cessation of the hormonal activity of the testicles, but after the age of 45 years in more than 38% of men, hormone production may decline, in some cases even earlier and present sexual disorders, which may complicate the relationship with a partner.
In women, when what is known as menopause occurs, it leads to the cessation of all ovarian activity and therefore of menstruation. It is not something that happens abruptly, but is preceded by a period of at least one year of perimenopause or transition phase, which runs from when the alterations of the menstrual cycle begin until the period disappears completely, usually between 45 and 55 years and can be so early that occurs around the age of 35 years.
What causes Andropause?
Several studies have shown that the passage of age is associated with a lower production of some hormones, especially sex steroids (androgens), growth hormone, melatonin and dihydroepiandrosterone (DHEA).
There is a gradual decline in testosterone over the years, but it is not comparable to the sudden drop in estrogen in women. This decline is seen from the age of 40-45 years and is a physiological decline. Testosterone values, both total and bioavailable, decrease in healthy males by approximately 1 to 2% annually from the age of 30.
This decrease in plasma testosterone is due to changes in testicular tissue due to cellular deterioration. The decrease in free testosterone is a consequence of the decrease in total testosterone production together with the increase in sex hormone binding globulin (SHBG) and therefore more importantly this leads to a decrease in available or free testosterone.
When should a specialist be consulted?
Generally, men are reluctant to consult, fearing that it is a sign of weakness or thinking that their self-esteem will be affected. However, this attitude can have negative consequences in their relationship, since the couple may interpret the low sexual performance as a sign of disaffection or infidelity, in this situation should consult a specialist.
The man who is in this state, will manifest a loss of libido and sometimes erectile dysfunction, and will present as general symptoms: a negative self-image, low tolerance to stress, anguish, anxiety and sleep disorders, easy tiredness and loss of vital energy, difficulty in concentration, all accompanied by loss of muscle mass with a tendency to osteoporosis and increased abdominal fat, all this polychromatism or constellation of manifestations, are compelling reasons to consult a specialist.
Treatment of Andropause
When in certain males, and due to the sum of other predisposing factors, the clinical situation of hypogonadism becomes evident and has negative repercussions on physical and mental health, they are considered patients.
Early diagnosis and correct treatment with appropriate hormone therapy will improve the psychological, physical and sexual aspects of the male. Men who, after the age of 40-45 years, suffer with anxiety the evident symptoms of andropause and feel more vulnerable, need the support of professionals who are experts in the field. Replacement therapy allows multiple routes of testosterone administration that the physician will choose according to the case and/or the patient’s preference.
Prevention of Andropause
There is some certainty that the clinical signs and symptoms, and testosterone values point to a true late hypogonadism, substitutive treatment is justified by its adherence to treatment with good results.
Although similar results could be obtained with changes in diet, weight loss if there is obesity, exercise, not smoking and eliminating stress as advised by some, but in this case there is a low percentage of performance and adherence to therapy.
For more information on andropause, consult an Endocrinology specialist.