Clinics specializing in andropause have emerged in recent years. If andropause is diagnosed, a hormone treatment with testosterone is sometimes prescribed. It is the only drug treatment currently available.

However, if the Erectile Dysfunction is the main symptom, taking a phosphodiesterase type 5 inhibitor (Viagra®, Levitra®, Cialis®) is often considered first. Depending on the case, a consultation with a psychologist or a sex therapist may be beneficial. See also our Male Sexual Dysfunction sheet.

In addition, the doctor will carry out a check-up, as the symptoms could be explained by a medical condition or an illness that has not yet been diagnosed. Weight loss, if indicated, and improvement of life habits are preferred before starting testosterone hormone therapy.

Testosterone hormone therapy

From what doctors observe in the clinic, some men would benefit from this treatment. This is because hormone therapy with testosterone may increase the libido, improve the quality of erections, increase the level ofenergy and strengthen the muscles. It could also contribute to a better bone mineral density. It may take 4 to 6 months for the therapeutic effects of testosterone to be fully manifested.¹³.

It is not known, however, whether hormone therapy provides testosterone risks for long term health. Studies are in progress. A potentially increased risk is mentioned:

• benign prostatic hyperplasia;
• prostate cancer;
• breast cancer;
• liver problems;
• sleep apnea;
• blood clots, which increases the risk of stroke.

This treatment is contraindicated in patients with uncontrolled heart disease, uncontrolled hypertension, prostate disorder or high hemoglobin.

Methods of administration of testosterone

• The transdermal gel. The gel (Androgel®, concentrated at 2% and Testim®, concentrated at 1%) is the product most often chosen, because it is quite easy to use while providing a more stable testosterone level than tablets and injections. It is applied daily to the lower abdomen, upper arms or shoulders, to clean, dry skin for maximum absorption (after a morning shower, for example). We must then wait 5 to 6 hours before wetting the skin, while the drug is absorbed. Be careful, however, the medication can be transmitted to the partner by skin contact;
• Transdermal patches. The patches also allow a very good absorption of the drug. On the other hand, they cause skin irritation for half of the people who try them, which explains why they are used less than the gel.¹⁴. A patch should be applied once a day to the trunk, stomach or thighs, each evening, varying the sites from one time to another (Androderm®, 1 mg per day);
• Tablets (capsules). Tablets are more rarely used because they are less convenient to use: they must be taken a few times a day. In addition, they have the defect of providing a variable level of testosterone. One example is testosterone undecanoate (Andriol®, 120 mg to 160 mg per day). Some forms of testosterone tablets present a risk of liver toxicity;
• Intramuscular injections. This is the first mode of administration to enter the market. It remains the least expensive, but requires going to the doctor or a clinic to receive the injection. For example, cypionate (Depo-Testosterone®, 250 mg per dose) and testosterone enanthate (Delatestryl®, 250 mg per dose) should be injected every 3 weeks. Some people can now give the injections on their own.