Andropause: what is it?
PasseportSanté.net has chosen to take stock of theandropause, although it is not a medically recognized syndrome. Andropause nevertheless reflects a current reality as more and more middle-aged men choose to undertake testosterone treatment. This treatment has been used for many years in young men with innate hypogonadism, i.e. in whom the production of sex hormones by the gonads (testes) is abnormally low due to a genetic problem. . However, it is only recently offered to healthy middle-aged men. |
We define theandropause like all the physiological and psychological symptoms that can accompany the low testosterone at themen aging. It would usually occur around 45 to 65.
Andropause, from the Greek andros, which means “man”, and pausis, “Cessation”, is often presented as the male counterpart of menopause. |
These symptoms range from decreased sexual appetite upon arrival of erectile problems through a feeling of being short of energy and drive. Periods of excessive sweating, problems with insomnia and weight gain could also add to the repercussions of a decline in sex hormone production.
Considered a dysfunction by some, as a reflection of the aging normal by others, andropause remains a controversial subject. What’s more, the only drug available, testosterone, has not been proven, either in terms of efficacy or safety.
Menopause for some, andropause for others? The comparison between andropause and menopause is rather lame. Andropause only affects a minority of men. Also, it does not mark the end of fertility. Moreover, the hormonal decline in humans is partial, progressive et inconstantunlike women, in whom hormones drop markedly over a short period of time. In men, a slight drop in testosterone production would start in their thirties or forties. From what experts have observed, the concentration of testosterone in the blood will decrease by about 1% per year. |
How many men affected?
Since theandropause is little known and rarely detected, we do not have exact data on the proportion of men who suffer from it.
However, according to a large study published in 2010, the European Male Aging Study, only 2% men aged 40 to 80 are experiencing an andropause: the proportion is 3% among those aged 60 to 69 and 5% among those aged 70 to 791. The diagnosis was based on the presence of symptoms of andropause and a lower than normal blood testosterone level.
These results indicate that testosterone treatment is suitable for very few men, according to the study’s authors.12. Most of the time, according to their observations, the symptoms are more related to aging, obesity or another health problem. In fact, 20% to 40% of men develop symptoms may resemble those of andropause with age11.
Really a question of testosterone?
La Testosterone is offered as a treatment atandropause for a little over ten years. The goal of treatment is to improve the quality of life by reducing symptoms. Pharmaceutical companies argue that testosterone could also delay the process of aging : less loss of muscle mass and risk of fractures, more sexual vigor, including better erections, etc. However, these effects have not been scientifically demonstrated.
Here are the main factors that make andropause treatment a delicate and complex subject:
- Le testosterone levels which reflects a “deficiency” in middle-aged men is unknown. In addition, this rate varies from man to man. The scales currently in use have a significant degree of imprecision and are based on averages established for young men;
- There is no symptoms specific to andropause. In other words, all the symptoms experienced can be the consequence of other health problems, such as depression, vascular problems or obesity;
- The association between low testosterone and symptoms of andropause is weak, according to various studies. Men with normal testosterone levels may experience symptoms of andropause. Some experts believe that andropause symptoms are more often the result of bad habits of life2,11;
- The benefits and risks treatment with testosterone are not clearly established by clinical trials, both short and long term. Some experts say testosterone hormone therapy is just an expensive placebo12. The main fear with this treatment in older men is that you increase the risk of prostate cancer or stroke. This is because testosterone increases hemoglobin levels and can slightly alter the lipid profile in the blood, increasing the risk of a blood clot forming in an artery in the brain. Other risks mentioned include: liver damage, breast development (which can become painful), testicular atrophy, increased aggressive or antisocial behavior and worsening of an existing health disorder (sleep apnea, mania, depression, etc. etc.). Like hormones prescribed to postmenopausal women, it is possible that in the aftermath that this testosterone treatment poses certain health risks. Studies are in progress;
- Other hormonal changes could explain the effects of andropause. DHEA (dehydroepiandrosterone), growth hormone, melatonin and, to a lesser extent, thyroid hormones also exert their influence.
Testosterone Testosterone is the predominant sex hormone in men. It is associated with vitality and virility. We owe him the appearance of male sexual characteristics at puberty. It also helps maintain bone health and muscle firmness and stimulates the production of sperm and red blood cells. The way fat accumulates in the body is also influenced by this hormone. Women also produce it, but in very small quantities. The testes make testosterone. The amount of testosterone produced depends on signals sent by glands located in the brain: the hypothalamus and pituitary. Various factors will promote or inhibit the production of testosterone. Sex, for example, stimulates her. Once produced, testosterone travels through the bloodstream and binds to receptors in various tissues, where it exerts its effects. |
Diagnostic
Treatment ofandropause being recent, the criteria leading to the diagnosis do not have a solid scientific basis.
The doctor first asks about the symptoms felt by his patient. He may use some assessment forms to better depict the intensity of symptoms, such as the AMS test (for Aging Male Score) or the ADAM test (for Androgen Deficiency of the Aging Male). To view these tests, see the Sites of interest section.
This is a good opportunity to establish a complete health check : blood tests (lipid profile, thyroid hormones, specific prostate antigen, etc.), portrait of cardiovascular health, overview of lifestyle habits. A list of drugs and natural health products consumed will complete the picture. This assessment will help to exclude other possible causes of the symptoms felt (anemia, depression, hypothyroidism, chronic fatigue syndrome, blood circulation problems, side effects of drugs, etc.).
Blood tests
Here are some explanations about the tests that are used to assess whether there is a testosterone deficiency.
According to the International Society for the Study of Aging Male (ISSAM), tests aimed at measuring blood testosterone levels should be part of the diagnosis since symptoms may not be related to andropause3. But these tests are done only if more than one symptom is manifested.
- Total testosterone levels. The result of this test includes both testosterone bound to a transporter (the sex hormone binding globuline or SHBG and, to a lesser extent, albumin) and testosterone which circulates freely in the blood;
- Free testosterone levels. This measurement is important since it is free testosterone that is active in the body. On average, about 2% of testosterone circulates freely in the blood. There is no test that directly measures the level of free testosterone. Doctors therefore estimate by calculation: they measure the rate of sex hormone binding globuline (SHBG) in the blood and then subtract it from the total testosterone level.