Andropause / “Low T” – The Male Menopause

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Having always been a normal physiologic phenomenon but only recently recognized, a decline of testosterone is experienced in middle-aged men around the same time women begin menopause. This decline is termed Andropause or “low T”. From its peak in the late teens and early 20’s, the production of testosterone begins its taper around the age of 35. By the age of 45, nearly 40% of men are affected by this decline. Typically, the symptoms of Andropause are mistaken for signs of aging and are not investigated.  Many males with age-related low testosterone are without overt symptoms however the physiologic decrease can cause changes in sexual function, mood, energy level and body composition. Adequate levels of testosterone are vital to the health and well-being of all men. Multiple studies have confirmed that men who fail to treat low levels of testosterone are at greater risk of disease. Type 2 diabetes, atrial fibrillation, peripheral artery disease and sleep apnea are some health issues associated with low testosterone.

 

SYMPTOMS OF ANDROPAUSE

Physical symptoms:

  • Bone Loss
  • Muscle Loss/Strength
  • Decreased flexibility (difficulty bending/kneeling)
  • Decreased endurance
  • Fatigue
  • Weight Gain
  • Gynecomastia (man boobs)

Sexual symptoms:

  • Erectile Dysfunction
  • Decreased Libido
  • Decrease of morning erections (<1/month)
  • Decrease of sexual thoughts (<3/month)

Psychological symptoms:

  • Irritability/Depression
  • Memory loss
  • Insomnia

Advancing age is the most common reason for low testosterone but stress, thyroid disease, some nutritional deficiencies (like low vitamin D levels)  and many common drug therapies can also lead to a decrease in levels of free testosterone.

Drugs known to lower testosterone levels in men:

 

  • Benzodiazepines
  • Opiates
  • SSRI’s
  • Cimetidine
  • Beta Blockers
  • Statins

ANDROPAUSE TREATMENT

Stress management, regular exercise, healthy nutrition, dietary supplements and hormone supplementation have all been shown to improve androgen levels in men.

Bio-identical testosterone replacement therapy has lately gained wide recognition and acceptance. In 2015, the American Association of Clinical Endocrinologists stated that testosterone therapy was a low risk, high reward treatment option.  This position was further reinforced with the results of a large, long-term Veteran Affairs Database study which showed that men restored to normal testosterone levels were at a reduced risk of heart attack or stroke.

When low testosterone levels are confirmed through testing, replacement with bio-identical testosterone is now an option. Creams, gels, injections or pellets are modes of delivery.  It is never given orally.  The goal of therapy is to restore testosterone levels to that of a 30 year old male.   It is necessary to carefully monitor testosterone levels during treatment.  Levels that are not physiologic (too low) will fail to be beneficial.  In elderly men, levels that are too high (supra-physiologic) have actually increased (rather than prevent) the risk of cardiovascular events.  Additionally, testosterone levels in the supra-physiologic range may paradoxically result in the return of symptoms as the testosterone receptors are ‘reset’.

You have your blood pressure, cholesterol and prostate routinely checked but what is your testosterone level?  Although decline of testosterone is a normal part of aging, replacing this hormone can be tremendously advantageous to a man’s physical, psychological, cognitive and sexual well-being.

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