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October 16, 2012

Andropause – The male menopause

Andropause or the male menopause is the term applied to the psychological and physical changes that the male body and mind undergo around the age of 45. These changes can start as early as the mid 30s and progress as he ages. The term andropause or the male menopause was coined about 20 years ago, but the changes were documented since 1944. There are several other words used to describe the male menopause and these include words such as ADAM, PADAM and SLOH.{{more}} These words describe the hormonal changes that take place in men as they age. Unlike women who go through a sudden “change of life”, men don’t. On the contrary, the changes in men are gradual. These changes result from a slow decline in the hormone testosterone in the man’s body. This decline eventually lead to a deficiency and low testosterone levels, hence the term ADAM or Androgen Deficiency or Decline in the Aging Male. Because the level of the testosterone declines slowly over the years from age 40, the changes that occur are also slow and result from hypogonadism or low testosterone levels. Hence, the SLOH or Symptomatic Late Onset Hypogonadism.

The symptoms of this andropause constitute what is classically known as the male “mid- life crisis”. These changes include:

1. A decrease in energy and drive, including sexual and physical energy and drive. The man becomes tired more often and takes longer to recover from it. He also loses sexual desire and has less firm erections, accompanied by less nocturnal erections.

2. Psychological changes include irritability, nervousness, fatigue, depression, anxiety, mood swings, difficulty concentrating, poor memory, and difficulty sleeping

3. Generalized aches and pains, including stomach cramps, headaches and lower back pain.

4. Physical changes include a decrease in the strength and bulk of the body muscle, a weakening of the bones or osteoporosis and an increase in body fat, especially that covering the internal organs.

5. The body also undergoes metabolic changes because of lower testosterone, with an increase in the cholesterol and lipid levels and an increased risk of hypertension, diabetes mellitus and heart attacks.

The problem with diagnosing andropause is because its symptoms occur gradually and most doctors take these symptoms as a normal part of ageing. Nevertheless, millions of men worldwide are affected by the symptoms and seek relief. So, even if the name used to describe the condition varies or is disputed, the symptoms remain the same, albeit of gradual onset. Additionally, difficulties arise with diagnosis, as men retain their fertility with andropause, unlike women who lose it with menopause, so the exact time of onset is difficult to detect. To make matters worse, the level of testosterone declines slowly over the years and what would be considered abnormally low in one man might be another man’s normal levels. The diagnosis is confirmed by checking the level of testosterone in his blood stream. If the levels are 200ng/ml or less, the man is diagnosed with hypogonadism and treatment is advised. Levels of testosterone above 600ng/ml virtually exclude hypogonadism. Clearly, the grey area is between 200 and 600 and this depends on the man’s symptoms. The blood test does not diagnose the disease on its own, as the blood test gives a result, but the result has to be interpreted in view of the man’s symptoms. In other words, ladies, if your man has the symptoms and his blood test is normal or borderline low, then he should be treated. Likewise, if he does not have the symptoms and some well meaning doctor did the test “just to see” and it comes back as low testosterone, we still will not treat, as that “low” testosterone might be his “normal”. In other words, we do not treat a blood test, but a patient. So, if the patient has symptoms and his blood test confirms the diagnosis then we treat and if he has no symptoms, irrespective of his blood test results, then we do not treat! Next week, we will discuss treatment.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com