Andropause

Andropause or male menopause^[1], sometimes colloquially called "man-opause" is a name that has been given to a menopause-like condition in aging men. This relates to the slow but steady reduction of the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men, and the consequences of that reduction,^[2] which is associated with a decrease in Leydig cells.^[3]

Unlike women, middle-aged men do not experience a complete and permanent physiological shutting down of the reproductive system as a normal event. A steady decline in testosterone levels with age (in both men and women) is well documented.^[4]

Unlike "menopause", the word "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification. This is likely because "andropause" is a term of convenience describing the stage of life when symptoms of aging appear in men. While the words are sometimes used interchangeably, hypogonadism is a deficiency state in which the hormone testosterone goes below the normal range for even an aging male.

As a "state"

The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers^[5] identified symptoms of what they labeled the "male climacteric" including loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. Heller and Myers found that their subjects had lower than normal levels of testosterone, and that symptoms decreased dramatically when patients were given replacement doses of testosterone.

Andropause has been observed in association with Alzheimer's disease.^[6]

In one study, 98.0% of primary care physicians believed that andropause and osteoporosis risk were related.^[7]

The term "symptomatic late onset hypogonadism" (or "SLOH") is sometimes considered to refer to the same condition as the word "andropause".^[8][9]

Some researchers prefer the term "androgen deficiency of the aging male" ("ADAM"), to more accurately reflect the fact that the loss of testosterone production is gradual and asymptotic^[10] (in contrast to the more abrupt change associated with menopause^{[citation needed]}.) The "D" is sometimes given as "decline" instead of "deficiency".^[8] In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.^[11]

As a disorder

Proponents

Proponents of andropause as a distinct condition claim that it is a biological change experienced by men during mid-life, and often compare it to female menopause. Menopause, however, is a complete cessation of reproductive ability caused by the shutting down of the female reproductive system. Andropause is a decline in the male hormone testosterone. This drop in testosterone levels is considered to lead in some cases to loss of energy and concentration, depression, and mood swings. While andropause does not cause a man's reproductive system to stop working altogether, many experience bouts of impotence.

Andropause is usually caused by a very gradual testosterone deficiency and an increase in sex hormone-binding globulin (SHBG) that occurs from age 35 onwards. By contrast, women have a more rapid onset of menopause at an average age of 51. Testosterone declines 10% every decade after age 30 (1% per year).

Premature andropause can occur in males who experience excessive female hormone stimulation through workplace exposure to estrogen. Men who work in the pharmaceutical industry, plastics factories, near incinerators, and on farms that use pesticides are high-risk for early andropause.^{[citation needed]}

By their mid-50s, about 30 percent of men experience andropause. About 5 million American men do not produce adequate testosterone, which leads to early andropause. In Australia, about 1 in every 200 men under the age of 60 and about 1 in every 10 men over 60 have low testosterone. Regardless of location, the most likely males to develop early andropause are those with diabetes, hypertension, and genetic disorders that produce hypogonadism, including Klinefelter's, Wilson-Turner, and Androgen insensitivity syndromes.

Some of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond, a lay person.^[12] According to Diamond's view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, generally between the ages of 40 and 55, though it can occur as early as 35 or as late as 65. The term "male menopause" may be a misnomer, as unlike women, men's reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives (at age 90 or older^[13]). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.^[14][15][16]

The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.^[17]

Opponents

Many clinicians believe that andropause is not a valid concept, because men can continue to reproduce into old age. Their reproductive systems do not stop working completely, and therefore they do not exhibit the sudden and dramatic drops in hormone levels characteristic of women undergoing menopause. In some men before the age of 60 there is a complete loss of libido, erectile function, and orgasmic ability.

Others feel that andropause is simply synonymous with hypogonadism or low testosterone levels.^[16] There is opposition to the concept of andropause in Europe as well as the U.S.^[18]

Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition. For example, people who are overweight may be misguided into treating a new illness rather than addressing the lifestyle that led to their being overweight. Similarly, energy levels vary from person to person, and for people who are generally inactive, energy levels will automatically be lower overall.

While it is true that active and otherwise healthy men could in theory develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.

Suggestions for treatment

Although there is disagreement over whether or not andropause is a condition to be "diagnosed" and "treated", those who support that position have made several proposals to address andropause and mitigate some of its effects.

• Morley emphasizes the importance of response to treatment, as well as testosterone level and identifiable symptoms.^[19]
• Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise.^[20]
• Diamond (a lay person) believes that depression is one of the most common problems of middle-aged men, and feels it is greatly under-diagnosed, sometimes with serious consequences.^[21]

The following treatments have been found to be effective.^{[12][15][17][21]} These include:

• Hormone replacement therapy^[22]
• Exercise, dietary changes, stress reduction ^[22]

Selective androgen receptor modulators have also been proposed.^[23]

See also

• Irritable male syndrome
• European Menopause and Andropause Society

References

1. ^ "Male Menopause". http://www.clevelandclinic.org/health/health-info/docs/3000/3001.asp?index=10094. Retrieved 2007-12-17. 
2. ^ MeSH Andropause
3. ^ Mahmoud A, Comhaire FH (2006). "Mechanisms of disease: late-onset hypogonadism". Nat Clin Pract Urol 3 (8): 430–8. doi:10.1038/ncpuro0560. PMID 16902519. 
4. ^ Mooradian AD, Korenman SG (2006). "Management of the cardinal features of andropause". Am J Ther 13 (2): 145–60. doi:10.1097/01.mjt.0000132252.80403.c9. PMID 16645432. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00045391-200603000-00011. 
5. ^ Heller, C.G., Myers, G.B., “The Male climacteric: Its symptomatology, diagnosis and treatment.” JAMA 1944; 126:472-77.
6. ^ Fuller SJ, Tan RS, Martins RN (2007). "Androgens in the etiology of Alzheimer's disease in aging men and possible therapeutic interventions". J. Alzheimers Dis. 12 (2): 129–42. PMID 17917157. http://iospress.metapress.com/openurl.asp?genre=article&issn=1387-2877&volume=12&issue=2&spage=129. 
7. ^ Pommerville PJ, Zakus P (2006). "Andropause: knowledge and awareness among primary care physicians in Victoria, BC, Canada". Aging Male 9 (4): 215–20. doi:10.1080/13685530601040661. PMID 17178557. http://www.informaworld.com/openurl?genre=article&doi=10.1080/13685530601040661&magic=pubmed. 
8. ^ ^{a b} "Columbia Presbyterian - Department of Urology". http://cumc.columbia.edu/dept/urology/What_is_hypogonadism_Intro.html. Retrieved 2007-12-17. ^{[dead link]}
9. ^ "There's help for "grumpy old men", but they're reluctant to admit to problem, says Queen's urologist". http://www.medicalnewstoday.com/articles/24551.php. Retrieved 2007-12-17. 
10. ^ Morales A (2004). "Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies". Aging Male 7 (4): 297–303. doi:10.1080/13685530400016664. PMID 15799125. 
11. ^ Tancredi A, Reginster JY, Luyckx F, Legros JJ (2005). "No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause'". Psychoneuroendocrinology 30 (7): 638–46. doi:10.1016/j.psyneuen.2005.02.002. PMID 15854780. http://linkinghub.elsevier.com/retrieve/pii/S0306-4530(05)00041-7. 
12. ^ ^{a b} Diamond, Jed (1998). Male Menopause. Naperville, Ill: Sourcebooks. ISBN 1-57071-397-9. 
13. ^ "Father, 90, shows off new baby" - timesonline.co.uk, retrieved 9/08/07
14. ^ Cetel, Nancy (2002). Double Menopause: What to Do When Both You and Your Mate Have Hormonal Changes Together. New York: Wiley. ISBN 0-471-40262-1. 
15. ^ ^{a b} Diamond, Jed (2000). Surviving Male Menopause. A Guide for Women and Men. Naperville, Ill: Sourcebooks. ISBN 1-57071-433-9. 
16. ^ ^{a b} Tan, Robert S. (2001). The andropause mystery: unraveling truths about the male menopause. Houston, Tex: AMRED Pub. ISBN 0-9707061-0-3. 
17. ^ ^{a b} Carruthers, Malcolm (2004). Androgen Deficiency in the Aging Male. London: Taylor & Francis Group. ISBN 1-84214-032-9. 
18. ^ Juul, A.; Skakkebaek, N. E. (2002). "Testosterone treatment of elderly men. The so called andropause doesn't exist." (in Danish). Ugeskr. Laeg. 164 (42): 4941–2. PMID 12416079. 
19. ^ Morley JE (2007). "The diagnosis of late life hypogonadism". Aging Male 10 (4): 217–20. doi:10.1080/13685530701695463. PMID 18033631. http://www.informaworld.com/openurl?genre=article&doi=10.1080/13685530701695463&magic=pubmed. 
20. ^ Mintz, A.P., Dotson, A. & Mukai, J. Hormone modulation, low glycemic nutrition, and exercise instruction: Effects on disease risk and quality of life. Journal of Anti-Aging Medicine, 4, 357-371, 2001. link
21. ^ ^{a b} Diamond, Jed (2004). The Irritable Male Syndrome : Managing the Four Key Causes of Depression and Aggression. Emmaus, Pa: Rodale Books. ISBN 1-57954-798-2. 
22. ^ ^{a b} Tan, Robert S. (205). Aging Men's Health: A Case-Based Approach. New York: Thieme Medical Publishers. ISBN 1-58890-296-X. 
23. ^ Tan RS, Pu SJ, Culberson JW (2003). "Role of androgens in mild cognitive impairment and possible interventions during andropause". Med. Hypotheses 60 (3): 448–52. doi:10.1016/S0306-9877(02)00447-4. PMID 12581627. http://linkinghub.elsevier.com/retrieve/pii/S0306987702004474. 

External links

• Andropause at the Open Directory Project
• independent advice on androgen deficiency
• Evaluation of Andropause
• PDF booklet discussing the condition
• information and self test