Andropause is the popular term for the condition associated with the physical, emotional, psychological and behavioral changes men experience as they age, but it goes by several aliases including late onset hypogonadism, male climacteric andropause, low testosterone, andropause syndrome, and androgen decline in the aging male (ADAM).1 Often considered the male version of menopause, and in some respects that's accurate, andropause is somewhat different.2 More specifically, both conditions represent age-related primary hormone declines, which if untreated can result in a variety of adverse symptoms. Although traditionally attributed to the aging process, many of the negative effects men start experiencing as they get older are caused by a significant decline in testosterone (the primary male hormone) production, resulting in diminished hormonal levels. Hypogonadic, or andropausal, men will frequently notice a gradual loss of energy, decrease in muscle mass, diminished mental focus and memory, increased body fat, reduced stamina, and a noticeable reduction in libido and sexual functioning.3
Of course testosterone is present in both males and females; however, males produce approximately ten times more testosterone than their estrogen-based female counterparts. Testosterone is the male body’s primary natural hormone, and is integral to male development from birth onward with responsibilities which include4: determining gender, moderating pubertal changes; maintaining male potency (libido & sexual functioning) and; the partitioning of bodily muscle and fat distribution. It is also foundational to a male's sense of well-being, and figures prominently in physiological, biological, and sexual health, while influencing sperm production, stress coping capacity, mental acuity (clarity, memory & recall, concentration & focus), bone density, red blood cell production, and immune system support. So it's easy to see why so many elements of health begin to breakdown as andropause progresses.
The primary difference between menopause and andropause is that of speed. Whereas menopause is a rather sudden, succinct, and more defined change andropause isn't. Its onset, and declining testosterone production, begins around age 30 and progresses (at a rate of approximately one percent per year).5 Researchers estimate the incidences of andropause in our society as follows: ages 40 to 49 at least 2% to 5% of men could be clinically diagnosed with the condition; ages 50 to 59 anywhere from 6% to 30%; ages 60 to 69 between 20% and 45%; ages 70 to 79 from 34% to 70% and; 80 plus at nearly 91%.6 Virtually all men will experience andropause, but not all men will experience hypogonadic symptoms severely enough to seek medical help.5 According to the U.S. Census Bureau, approximately 15 million men have low testosterone levels, of which only 5-10% of these men will seek treatment,6 largely because many don’t realize this condition is correctable.5
Symptoms of Andropause
- Low hemoglobin and possibly mild anemia
- Loss of bone density which increases the risk of osteoporosis, fractures, and breaks
- Declining strength, and reduced lean body mass
- Increased body fat (visceral, adipose, and subcutaneous)
- Lower energy levels, and reduced interest in usual activities
- Atypical cholesterol and lipid values
- Loss of hair thickness and/or amount
- IMS (Irritable Male Syndrome) - mood swings, irritability, depression, anger, and fatigue
- Loss of sexual desire (libido) and/or various forms of erectile dysfunction (ED)
Although the above symptoms are most commonly attributed to andropause, this condition is also driven by your level of stress, quality of nutrition, amount of exercise and the environmental toxins you are exposed to on a daily basis.19 Some of these symptoms can even be caused by other diseases and conditions such as diabetes, thyroid problems, medication side effects, depression, and excessive alcohol use.20 Testing is important to properly diagnose low testosterone levels.
Testing For Andropause
Actually, routine physicals should expose this condition, but when advanced age is present in conjunction with complaints of traditional andropause related symptoms, physicians will typically employ a simple blood test to measure testosterone levels,21 along with the levels of both 'bound' (that which is attached to Sex Hormone Binding Globulin - SHBG), and 'free' (unbound) testosterone.22 Deficiency is usually diagnosed when testing returns a total serum level near or below the established lower limit, which is generally 350 nanograms per deciliter (ng/dl). The blood test should be administered in the morning, prior to daily stressors which can influence testosterone production such as work, exercise, medication, etc. Other measured hormone levels which usually accompany the testosterone measurement include DHEA, FSH, LH, and Estradiol. All blood testing should be conducted from 8:00-9:00 AM, when blood serum concentrations are at their peak.23
The Clinical Rational For Testosterone Replacement Therapy
Testosterone replacement should in theory approximate the natural (endogenous) production of the hormone. The average male produces 4-7 mg of testosterone per day in a circadian pattern, with maximal plasma levels attained in early morning and minimal levels in the evening.24 Ideal testosterone replacement therapy produces and maintains physiologic serum concentrations, without significant side effects or safety concerns.25 There are different variations (preparations, esters, blends, etc.) of synthetic testosterone each with its own unique properties, and respective methods of action26272829. Here at Empower Pharmacy the most commonly requested testosterone preparations are injectable and transdermal forms.
Intramuscular Injection (IM) testosterone preparations are shot directly into the muscle, and then absorbed into the bloodstream via the capillaries. This is an extremely popular preparation due to its highly accurate dosing, varying time release qualities, and insignificant hepatotoxicity levels.
Testosterone (Enanthate, Cypionate, and Propionate) is approved by the U.S. Federal Drug Administration (FDA) to treat hypogonadism.
- Improves mood, memory, energy, libido, and erectile function; increases muscle mass, strength, and bone density; and reduces subcutaneous, visceral, and adipose fat.330313233343536
- Possible side effects: abnormal liver function test; acne; gynecomastia; halitosis; vivid dreaming, increased appetite; night sweats
Transdermal (Topical) testosterone preparations can be made in cream or gel preparations and are rubbed into the skin and absorbed through it. Transdermals can be provided in different strengths ranging from 10 mg to 200 mg per milliliter. For optimal benefit, twice daily doses are recommended once upon waking, and again later in the day at consistent times.
- Testosterone creams/gels are approved by the FDA to treat hypogonadism.
- Improves...same as IM
- Possible side effects: same as IM
Monitoring Patients on Testosterone Replacement
Patients on testosterone replacement therapy should be monitored to ensure that testosterone levels are within normal ranges.5 The prescribing physician should continually evaluate changes in hypogonadic symptoms, and address treatment side effects. Serum testosterone levels should be checked 5 to 7 hours after application of transdermal delivery systems, when concentrations are highest.5
Men forty and older should have a PSA test prior to therapy, and it should be repeated in 3-6 months, and then checked annually.21 A confirmed increase in PSA >2 ng/mL, or a total PSA >4.0 ng/mL requires urologic evaluation.21 The hematocrit level should also be checked at baseline, at 3-6 months, and then annually. A hematocrit >55% warrants evaluation for hypoxia and sleep apnea, and/or a reduction in the testosterone therapy dosage.21 Hypogonadal men with osteopenia should be having bone mineral density of the lumbar spine and/or the femoral necks tested after one year.
Living with Andropause
So as you can see living with andropause isn't the downhill spiral that it used be. Now that scientist better understand the syndrome, and physicians are equipped with the tools to combat its aversive symptoms, your golden years can be much more enjoyable.
Working closely with your health care provider, Empower Pharmacy can tailor a prescription to the exact strength that you require in the form that's easiest for you to use, thereby transforming this phase of life into one of verve, virility, and continued activity.
- 1. Am J Mens Health. 2013 Nov; (6):516-22. Prevalence of andropausal symptoms among Kuwaiti males. Maha AS.
- 2. Rieder A, Kunze M. "Menopause and Andropause-The Socio-Medical Viewpoint". Monopause/Andropause: hormone replacement therapy through the ages - New cognition and therapy concepts: 15-19.
- 3. a. b. Aging Male. 2012 Mar;15(1):14-21. The effect of testosterone supplementation on depression symptoms in hypogonadal men from the Testim Registry in the US (TRiUS). Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM.
- 4. Sisk C, Lonestein J, Gore A. "Critical Periods During Development: Hormonal Influences on Neurobehavioral Transitions Across the Life Span." Neuroscience in the21st Century. 2013, pp 1715-1752.
- 5. a. b. c. d. e. Mulligan T. Andropause: Pathophysiology, Prblems, and Practice Guidelines. Virginia Geriatrics.
- 6. a. b. Rieder A, Kunze M. "Menopause and Andropause-The Socio-Medical Viewpoint". Monopause/Andropause: hormone replacement therapy through the ages - New cognition and therapy concepts: 15-19.
- 7. Am J Psychiatry. 1998 Oct;155(10):1310-8. Age-associated testosterone decline in men: clinical issues for psychiatry. Sternbach H.
- 8. Reprod Fertil Dev. 2001;13(7-8):567-76. The irritable male syndrome. Lincoln, GA
- 9. Arch Esp Urol. 2013 Sep;66(7):729-736. Patients with testosterone deficit syndrome and depression. Khera M.
- 10. Endocr J. 2012 Dec 28;59(12):1099-105. Increased frequency of anxiety, depression, quality of life and sexual life in young hypogonadotropic hypogonadal males and impacts of testosterone replacement therapy on these conditions. Aydogan U, Aydogdu A, Akbulut H, Sonmez A, Yuksel S, Basaran Y, Uzun O, Bolu E, Saglam K.
- 11. J Clin Endocrinol Metab. 2000 Jan;85(1):60-5. Effects of hypogonadism and testosterone administration on depression indices in HIV-infected men. Grinspoon S, Corcoran C, Stanley T, Baaj A, Basgoz N, Klibanski A.
- 12. Int J Obes Relat Metab Disord. 2003 May; 27(5): 610-6 A biometric study of basal metabolism in man. Harris J, Benedict F.
- 13. World J Mens Health. 2013 Aug;31(2):126-135. The Relationship between Testosterone Deficiency and Men's Health. Tsujimura A.
- 14. Eur J Endocrinol. 2013 May 2;168(6):829-43. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Corona G, Rastrelli G, Monami M, Saad F, Luconi M, Lucchese M, Facchiano E, Sforza A, Forti G, Mannucci E, Maggi M.
- 15. J Sex Marital Ther. 2011;37(4):243-54. Androgen replacement therapy improves psychological distress and health-related quality of life in late onset hypogonadism patients in Chinese population. Zhang XW, Liu ZH, Hu XW, Yuan YQ, Bai WJ, Wang XF, Shen H, Zhao YP.
- 16. Chin Med J (Engl). 2012 Nov;125(21):3806-10. Short term testosterone replacement therapy improves libido and body composition. Andrade ES Jr, Clapauch R, Buksman S.
- 17. Arq Bras Endocrinol Metabol. 2009 Nov;53(8):996-1004. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. Kapoor D, Goodwin E, Channer KS, Jones TH.
- 18. Eur J Endocrinol. 2006 Jun;154(6):899-906. Transdermal testosterone therapy improves well-being, mood, and sexual function in premenopausal women. Goldstat R, Briganti E, Tran J, Wolfe R, Davis SR.
- 19. Bansal VP. "Andropause". Journal of Universal College of Medical Sciences. 2013;1(2):54-68.
- 20. Bansal VP. "Andropause". Journal of Universal College of Medical Sciences. 2013;1(2):54-68.
- 21. a. b. c. d. Casulari L, Motta L. "Diagnostic of Andropause: a problem not yet Solved". Arq Bras Endocrinol Metab. 2008;52(9):1401-2.
- 22. Asian J Androl. 2013 Dec 19. Late-onset hypogonadism: Current concepts and controversies of pathogenesis, diagnosis and treatment. Huhtaniemi I.
- 23. Mulligan T. Andropause: Pathophysiology, Prblems, and Practice Guidelines. Virginia Geriatrics.
- 24. Hayes L et al. "Diurnal Variation of Cortisol, Testosterone, and Their Ratio in Apparently healthy Males". Sport Spa;9(1):5-13.
- 25. Winters S. "Current Status of Testosterone REplacementTherapy in Men". Archives of Family Medicine. Jun 1999;8:257-63.
- 26. https://empower.pharmacy/drugs/testosterone-cream.html
- 27. https://empower.pharmacy/drugs/testosterone-cypionate-injection.html
- 28. https://empower.pharmacy/drugs/testosterone-enanthate-injection.html
- 29. https://empower.pharmacy/drugs/testosterone-propionate-injection.html
- 30. J Affect Disord. 1998 Mar;48(2-3):157-61. Testosterone replacement therapy for hypogonadal men with SSRI-refractory depression. Seidman SN, Rabkin JG.
- 31. J Sex Med. 2009 Jul;6(7):2049-57. Hypogonadism, decreased sexual desire, and long-term depression in middle-aged men. Hintikka J, Niskanen L, Koivumaa-Honkanen H, Tolmunen T, Honkalampi K, Lehto SM, Viinamäki H.
- 32. J Clin Endocrinol Metab. 2000 Aug;85(8):2839-53. Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men. Wang C, Swerdloff RS, Iranmanesh A, Dobs A, Snyder PJ, Cunningham G, Matsumoto AM, Weber T, Berman N.
- 33. J Clin Endocrinol Metab. 2000 Aug;85(8):2670-7. The sexual effects of testosterone replacement in depressed men: randomized, placebo-controlled clinical trial. Seidman SN, Roose SP.
- 34. J Sex Marital Ther. 2006 May-Jun;32(3):267-73. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). Khera M, Bhattacharya RK, Blick G, Kushner H, Nguyen D, Miner MM.
- 35. J Sex Med. 2011 Nov;8(11):3204-13. The effects of treating male hypogonadism on couples' sexual desire and function. Conaglen JV, Conaglen HM.
- 36. J Sex Med. 2009 Feb;6(2):456-63. Testosterone gel replacement improves sexual function in depressed men taking serotonergic antidepressants: a randomized, placebo-controlled clinical trial. Amiaz R, Pope HG Jr, Mahne T, Kelly JF, Brennan BP, Kanayama G, Weiser M, Hudson JI, Seidman SN.