Read our new article on Testosterone Replacement Treatments.
We often hear of the horrid effects menopause has on older women. With men approaching their senior years, is it also possible that they experience similar effects as well?
Doctors do not really like the term ‘andropause’. It generates certain misconceptions that it is simply ‘male menopause’. There are some very important differences between andropause and menopause. First, unlike menopause, andropause does not automatically occur in all men when they reach a certain age. Secondly, unlike menopause, andropause is not associated with infertility. Thirdly, andropause occurs gradually over years as opposed to menopause which develops over a relatively short period of time.
However, there are certain similarities in both these conditions. Both conditions are due to a decrease in hormones in the body. In ladies it is a decrease in estrogen that is responsible. In men the culprit hormone is testosterone. Just like in menopause, men in andropause can experience weakening of their bones. Men can also experience hot flushes but this is uncommon and usually only occurs if severe situations. Although men do not experience the mood swings so often associated with menopause, they will experience psychological symptoms such as a depressed mood, loss of concentration and feeling burnt out.
What exactly is andropause, and are certain men more susceptible to it?
As men age, the Testosterone level in the body drops. This can lead to many different symptoms. A man suffering from these symptoms due to a drop in his Testosterone level is said to be having Andropause.
There is no one commonly agreed on definition of andropause in current medical literature. It is generally accepted that andropause is a collection of symptoms resulting from a decrease in testosterone due to aging. Men who are obese or suffer from chronic diseases such as diabetes seem to be more at risk of andropause.
Andropause is known by many other names including Age Related Hypogonadism, Hypogonadotrophic Hypogonadism, Testosterone Deficiency Syndrome and Late onset Hypogonadism.
For men going through this condition, how does it affect them? Psychological wise, how does andropause affect patients?
Outwardly, andropause has several noticeable symptoms namely, reduced libido, erectile dysfunction, decreased muscle strength, depressed mood, decrease concentration, decreased beard growth and tiredness. Internally, andropause is associated with decreased bone strength, increased internal fats, decreased muscle mass and decreased HDL (good) cholesterol.
Psychologically, andropause is associated with increased anxiety, depressed mood and decreased concentration. Men describe it as feeling ‘burnt out’ or ‘passed their peak.’
Most people with Andropause will complain of a decline in general well being, feeling burnt out or feeling that they have passed their peak.
To find out if you are suffering from the symptoms of Andropause, fill out this Aging Male Symptoms Questionaire. If you score more than 37, it is likely you have Andropause.
Unfortunately, the symptoms of Andropause can also be caused by many other diseases such as low Thyroid Hormone levels, Clinical Depression etc. It is best to see your Doctor and have a blood Testosterone test done. If your Testosterone level is low, it is likely you have Andropause.
Based on your estimation, how common do you think this condition is among men?
Various international studies have estimated the prevalence of andropause at about 20% to 30% of men above the age of 60. From my experience, the situation in Singapore is similar.
Unlike Menopause, Andropause does not happen to every male. Factors such as obesity, Diabetes, High Cholesterol and Hypertension have been associated with a higher incidence of Andropause.
Conversely, Andropause can increase the chance of getting lifestyle diseases such as Diabetes, High Cholesterol and High Blood Pressure.
With andropause, what are the tell tale signs?
Unfortunately, there are no specific signs for andropause. Some of the more specific signs are loss of libido, decreased beard growth and decreased muscle strength. The other symptoms are very non-specific and can be caused by a variety of conditions including depression, diabetes, low thyroid levels and other chronic diseases.
How is the condition diagnosed? What tests would patients have to go through?
First of all, the doctor will take a thorough history to make sure there are no features that suggest any other chronic diseases. If there are, he may then suggest some tests to rule out diseases such as depression, diabetes or thyroid problems. If the doctor suspects andropause, he will document all the various symptoms that are typically associated with andropause. This is important as we have to verify an improvement in these symptoms if the patient decides to undergo treatment. The test specific for andropause is a blood test for testosterone. This test is best done in the morning before 11am. Sometimes the results are not conclusive and doctors will have to repeat the test. Also, doctors might have to do other hormone tests to see if the decrease in testosterone is indeed due to aging or due to some other issues. If it is decided by the patient and his doctor that testosterone treatment is necessary, the patient will have to test his prostate and blood count before starting treatment.
From your experience, are patients often unaware that they may be going through andropause? Are they embarrassed upon finding out they have andropause? How can they cope?
Yes, the majority of patients are unaware that they are going through andropause. Most blame their symptoms on lack of exercise or an improper diet or working too hard or being too stressed at work. Most of the time they just put it aside as ‘getting old’. It is however important to remember that andropause symptoms are non-specific. In other words, we cannot automatically blame everything on andropause. It is important to see a doctor and get properly diagnosed.
Most men are not embarrassed at all when they find out that they are going through andropause. On the contrary, most of them are relieved that there is a proper medical explanation for their symptoms. They are even more relieved to find out that there is effective treatment available.
There is currently very effective and convenient treatment for andropause. There is no need for men to suffer its effects indefnitely.
What are the Treatments available for Andropause?
The key is to replace Testosterone into the body. There are 3 methods to do this.
Testosterone Gels are painless and easy to use. It is applied twice a day onto the shoulders or thighs. After application you must not bathe or swim for 6 hours to give the gel time to absorb. You must also be careful not to transfer any of this gel onto a female person.
Testosterone pills are taken 2 to 3 times a day. They should be taken with food, preferably slightly greasy food. This is because Testosterone is soluble only in oil. Taking Testosterone pills on an empty stomach might reduce the absorption by up to 50%.
Testosterone injections are very convenient. The latest preparations require only 1 injection every approximately 3 months. The absorption into the body is very constant and there is no need for you to do anything in between the injections.
Are there any side effects of Testosterone Treatment?
Testosterone should NOT be given to someone with Prostate Cancer. Your Doctor will do an examination and blood test for you to rule out Prostate Cancer before giving you Testosterone.
However, Testosterone DOES NOT cause or increase the risk of Prostate Cancer in normal men. In fact, Testosterone treatment has been shown to reduce the level of PSA (Prostate Specific Antigen) which is a marker for Prostate Cancer.
Testosterone might also increase the number of red blood cells in your body. This does not cause any problems unless the increase is tremendous. You Doctor will monitor you red cell count with a blood test.
Need more advice?
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.