Andropause: Ironing out the Bumps on Life's Road

Winter 2003 CSANews Issue 49  |  Posted date : May 02, 2007.Back to list

While there is much written about female menopause, a similar phenomenon called andropause occurs in many men, and has recently attracted considerable research and attention. In fact Dr. Alvero Morales, professor of urology at Queen's University and a founding member of the Canadian Andropause Society, was recently given a major international award for his contributions to the field of andropause and in the treatment of bladder cancer and erectile dysfunction.
Initially described in the 1940s, andropause is now a proven phenomenon characterized by declining testosterone levels in men in their middle and later years. Such changes in hormonal levels can be associated with a number of effects including:

  • low sex drive and erectile dysfunction
  • loss of muscle strength
  • decrease in muscle mass
  • increase in upper and central body fat
  • changes in attitudes and moods
  • lack of energy

But for many years, such symptoms could not be linked to declining testosterone levels. Accurate testing for bio-available testosterone has only been developed in the past few years, allowing physicians to finally isolate those individuals in need of hormone replacement therapy. In addition, some or all of the symptoms can be vague and ascribed by some men as due to other conditions or their age, and resulting in them not seeking medical attention.

Testosterone is a hormone produced mainly in the testes and affecting many different parts of the body. In addition to its necessity for normal sexual behaviour including achieving erections, it has effects on blood cell production, lipid metabolism, carbohydrate metabolism, prostatic growth and liver function.

Unlike women, who have the clear indication of cessation of menstruation marking the transition, the signs and symptoms in men are often insidious and more difficult to ascribe to this phenomenon. In the past, such symptoms were usually blamed on the natural aging process or in some cases "depression." However, modern techniques including sophisticated measurement of the level of testosterone in suspected cases, can confirm the diagnosis. And as Dr. Morales states, "Andropause is a significant and real disease. It is an important life phase for men that needs to be better recognized by the general public and by health-care practitioners at all levels."

While not all men experiencing symptoms as indicated will have abnormally low testosterone levels for their age group to explain these effects, it is estimated that up to 30 per cent of men in their fifties will have testosterone levels low enough to be causing symptoms. And low levels of the hormone may also put them at risk for other more serious conditions, including osteoporosis and coronary artery disease.

Although there is current evidence of a protective effect of testosterone against both bone fractures and heart attacks, the use of testosterone replacement must be based on the laboratory evidence of an abnormally low level of the natural bio-available hormone. In such cases, testosterone replacement has been shown to be highly effective and very beneficial. In other words, the presence of such symptoms as described can only be attributed to andropause and the need for hormone replacement when proven by laboratory tests. Otherwise, other health problems should be considered and other remedies chosen.

But when the condition is diagnosed and testosterone replacement is initiated, improvement can be experienced as soon as three weeks later. Patients describe a return of mental and physical well-being, improved libido and sexual performance, an increase in muscle mass and strength and a general improvement in mood and enjoyment of life.

Many of us connect the use of testosterone to professional athletic performance and all the related adverse health issues. The types of testosterone replacement in the treatment of andropause are much less toxic and, if prescribed in appropriate form and dosage, are much safer. Nevertheless, the long-term effects of this potent medication have not been fully researched and much like hormone replacement therapy in women, it may take years before thorough large-scale studies clarify the benefits versus potential adverse effects, especially regarding increased risk of prostatic cancer. Physicians of individuals diagnosed with a deficient level of testosterone must monitor current scientific evidence that the benefits outweigh the risk and, as yet, there is not a lot of research on this subject. Women and their physicians are well aware of the change in attitude towards hormone replacement for them. While once widely held to be useful in the prevention of osteoporosis and heart disease, recent reputable studies have revealed that the risks of heart disease, certain cancers and blood clots actually increase in women using long-term hormone replacement. In fact, the U.S. Food and Drug Administration launched an education campaign in September, saying that women should only consider hormone replacement therapy for the shortest possible period at the lowest possible doses. Whether similar warnings may appear in the future about the long-term replacement of testosterone in male patients is unknown at this time.

One of the most common symptoms experienced is that of erectile dysfunction. Chronic inability to achieve erection, an inability to effectively maintain erection or an inconsistent ability to do so probably affects more than 25 per cent of men by age 65. Yet inadequate testosterone levels probably account for fewer than five per cent of men suffering from impotence. Other causes for the majority of cases include vascular disease (arteriosclerosis), diabetes, drugs, excess alcohol intake, neurologic conditions, pelvic trauma, surgery, radiation therapy and psychological conditions. Sorting out the likely cause with one's physician can in many cases lead to a resolution of the problem, or at least improvement in sexual performance.

What if some or all of the presenting signs and symptoms mentioned above cannot be attributable to significant abnormal testosterone levels? Too often, they are then discounted and no further evaluation or treatment is recommended. Many such symptoms are in fact treatable.

There are well-recognized medical and surgical treatments for erectile dysfunction. It is important to first rule out causes that require specific treatment. If the problem is due to low testosterone levels, the treatment is hormone replacement. There is a long list of prescription drugs which are known to cause or contribute to impotence, including drugs for high blood pressure, heart medications, tranquillizers and sedatives. Excessive alcohol intake not only affects immediate performance, but can have lasting effects on the vascular and nervous systems. Diabetes control is important in reducing the development of impotence in such patients, as it is estimated that impotence afflicts 60 per cent of men with diabetes. And although overrated as a cause of erectile dysfunction and loss of libido in the past, psychological conditions including depression, guilt, worry, stress and anxiety can still be major contributing factors.

Surgical solutions to erectile dysfunction, although once quite popular, have largely been replaced by the discovery of Viagra. This drug is used solely by men suffering from erectile dysfunction and has been extremely successful. Although expensive, it has a very high success rate and is relatively safe. Men suffering from heart disease, blood pressure conditions, liver conditions and those on any form of nitrates should not take Viagra. As always, one's personal physician will determine whether a prescription is suitable.

Andropause Treatment for Men with Low Testosterone
Once a morning blood sample demonstrates an inadequate level of bio-available testosterone, replacement therapy can be administered in several forms.

  • Orally: Testosterone nudecanoate (Andriol)
  • Injectable: Testosterone cypionate (Depo-Testosterone Cypionate) or Testosterone enanthate (Delatestryl) usually given as an intra-muscular injection every two weeks
  • Other routes of administration include patches (Testoderm TTS and Androderm), gels (AndroGel) and a metered dermal spray (Testocream), but these are currently available only in U.S.

Careful monitoring of testosterone levels, as well as routine liver function tests and physical examinations, are a necessary adjunct to treatment.

The recent advances in the management of such symptoms are significant and with the help of a concerned physician, can often be ameliorated if not eradicated.

So don't be too quick to conclude that some of your symptoms are just a part of a normal aging. Some may be due to andropause and many may be treatable. Consult your physician. Research on the Internet. As Mae West once said, "You're never too old to become younger."