Men's Health

What is Andropause?

By the time men are between the ages of 40 and 55, they can experience a phenomenon similar to the female menopause. The bodily changes occur very gradually in men and may be accompanied by changes in attitudes and moods, fatigue, a loss of energy, sex drive and physical ability. These changes could be linked to hormonal changes. Studies show that this decline in testosterone can actually put one at risk for other health problems like heart disease, diabetes and weak bones. This happens at a time of life when many men begin to question their values, accomplishments and direction in life and become depressed. The decline in testosterone in men is much more gradual, than the estrogen decline in women, and may expand over many decades. Attitude, psychological stress, alcohol, injuries or surgery, medications, obesity and infections can contribute to its onset.

Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting who will experience andropause symptoms of sufficient severity to seek medical help. Neither is it predictable at what age symptoms will occur in a particular individual. Each man's symptoms may be also different.

Increased diagnostic capability

One reason why andropause has been under diagnosed over the years is that symptoms can be vague and can vary a lot among individuals. Some men find it difficult to admit that there's even a problem. Often physicians didn't always think of low-testosterone levels as a possible culprit. So these factors often led doctors to conclude that symptoms were related to other medical conditions (i.e. depression) or were simply related to aging and often encouraged their patients to accept that "they were no longer spring chickens".

Starting at about age 30, testosterone levels drop by about 10 percent every decade. At the same time, another factor in the body called Sex Hormone Binding Globulin, or SHBG, is increasing. SHBG traps much of the testosterone that is still circulating and makes it unavailable to exert its effects in the body's tissues. What's left over does the beneficial work and is known as "bioavailable" or free testosterone. Aromatization (conversion of testosterone to estrogen) is another problem associated with andropause. A deficiency in zinc can cause an increase in aromatization. Estrogens will cause an increase in body fat, and as body fat increases more aromatase is produced. It becomes a vicious cycle. Therefore it is necessary to test not only for free testosterone but free estradiol.

Andropause is associated with low free testosterone levels and/or elevated free estradiol. Every man experiences a decline of free testosterone but some men's levels dip lower than others. And when this happens these men can experience andropause symptoms. It is estimated that 30 percent of men in their 50s will have testosterone levels low enough to be causing symptoms or putting them at risk.

Importance of Testosterone

Testosterone is a hormone that has a unique effect on a man's total body. Testosterone helps to build protein and is essential for normal sexual behavior and producing erections. It also affects many metabolic activities such as:

     • Production of blood cells in the bone marrow
     • Bone formation,
     • Lipid metabolism
     • Carbohydrate metabolism
     • Liver function
     • Muscle growth.

Impact of Low Testosterone

When there is less free testosterone available to do its work, the testosterone target-organ response decreases, bringing about many changes. There is great variability in testosterone levels among healthy men so not all will experience the same changes to the same extent. But typical responses to low free testosterone levels include:

     • Low sex drive
     • Emotional, psychological and behavioral changes including        depression
     • Decreased muscle mass
     • Increased body fat
     • Loss of muscle strength
     • Increased upper and central body fat
     • Osteoporosis or weak bones and back pain
     • Cardiovascular risk


Testosterone Replacement Therapy

In many instances, testosterone replacement in men with andropause can be highly effective and beneficial. It's not for every man, of course, even those who show symptoms on the Androgen Deficiency in Aging Males (ADAM QUIZ) may have other health problems at the root of it all. Still you should discuss with your doctor if you would be a good candidate for testosterone replacement therapy.

What should I expect from testosterone replacement?
In various clinical studies, very good responses to testosterone have been reported for men with low-testosterone and they include:

       • Improvement in mood and sense of well-being
       • Increased mental and physical energy
       • Decreased anger, irritability, sadness, tiredness, nervousness
       • Improved quality of sleep
       • Improved libido and sexual performance
       • An increase in lean body mass, a decline in fat mass
       • An increase in muscle strength (hand grip, upper and lower extremities) 
       • Potentially, a decrease in the risk of heart disease

With testosterone therapy, one's attitude may improve, reinforcing self-esteem and self-confidence at work, as well as an increased energy at home and in social activities. Most men will feel more vigorous; experience improved energy levels, mood, concentration, cognition, libido, sexual performance and an overall sense of well being. These effects are usually be noted within 3 to 6 weeks. Other potential benefits include maintenance or improvement in bone density, improved body composition, muscle mass, less body fat and muscle strength.

Talk to Your Doctor

Your doctor will check carefully to see if you are a suitable candidate for testosterone replacement therapy, including performing blood tests and a physical examination. If you have an established prostate tumor or have breast cancer you would not be a suitable candidate for testosterone replacement therapy. 

However, if you are a candidate for testosterone replacement therapy, the options include, injections, transdermal creams, lotions, gels and sublingual (under the tongue) tablets and troches. Expect your physician to monitor your progress and your overall health while on testosterone treatment. If you are like the majority of men, you will experience very few side effects, if any.
Testosterone therapy is shown to be highly effective at relieving andropause symptoms, usually within 3 to 6 weeks. Most men feel more vigorous; have improved sexual performance and a better sense of well being. 
Why not try the ADAM QUIZ, to determine if you should see your doctor about low-testosterone symptoms. 

Therapeutic Choices

Transdermal creams, lotions and gels in various concentrations to meet each individual unique need. Higher strength topical preparations allow for the use smaller quantities and more convenient doses. Chrysin a flavanoid can be add to the topical preparations to help inhibit the conversion of testosterone to estrogen.

Injections in various strength can be prepared to meet each patient’s unique need.

Sublingual Dosage Forms (under the tongue) in various strengths can be prepared.