Andropause, otherwise known as ADAM or androgen deficiency in adult males, has been known about since the 1940’s. Symptoms in males were observed and reversed with testosterone treatment.
It is similar to female menopause in that it is caused by a natural decline in sex hormones over time.
Rather than a decline in oestrogen, as seen in women, it is a decline in the male sex hormone testosterone, sometimes referred to as an androgen. These testosterone levels naturally decline by 1-2% per year after the age of 30. The incidence (number of new cases) is about 12/1000 in 40-70 year olds.
Whilst andropause is a natural occurrence, various factors can accelerate it. These include obesity, poor diet, lack of exercise, chronic illness, under active thyroid, alcohol, smoking, stress, anxiety and depression. The way that andropause presents is, as with menopause, highly individual. However, certain symptoms and signs are more common than others. These can be divided into physical and emotional/mental and sexual.
Physical Andropause Manifestations
Physical manifestations include loss of muscle mass and strength, increased body fat especially around the trunk, reduced bone density, hot flushes, sweating especially at night and hair loss especially on the scalp.
Emotional/Mental Andropause Manifestations
Emotional/mental manifestations include Difficulty falling asleep, insomnia, difficulty staying asleep, mood swings, irritability, anxiety, depression, poor memory and concentration and low self-esteem. Of course, there is a chicken and egg argument to be made for some of these issues.
Sexual Andropause Manifestations
Sexual manifestations include reduced libido, erection problems, impaired ejaculation and infertility. These can lead to and worsen the emotional symptoms of andropause.
Diagnosis
Diagnosis of andropause is far from straight forward. Education about its diagnosis and treatment is patchy at a primary care level so referral is often needed to a specialist. A detailed medical questionnaire is needed to elicit symptoms and exclude other diseases. This is followed by a raft of blood tests both to aid diagnosis and to exclude other diseases with similar symptoms.
Some of the more common tests done to aid a positive diagnosis include:
- Testosterone – A normal testosterone level does not mean that you aren’t going through the andropause. Basically, there are two types of testosterone measured – Total and Free testosterone. The difference is that some of your hormone is ‘free’ to work on the body and the rest is stuck to another molecule that stops it having an effect.
- SHBG – The molecule that sticks to testosterone is SHBG or serum hormone binding globulin. The levels of this increase with age, stress, reduced exercise, increased weight etc.
So you can see that as these levels increase the amount of your testosterone that is free to have an effect on your body is reduced, leading to the symptoms and signs of andropause. If you combine this with an age related reduction in the total amount of testosterone, then it’s a double whammy. It also means that you can be going through the andropause and have a normal total testosterone level.
Very confusing! Hence the need for specialist referral. Many other tests are done which are beyond the scope of this blog.
The Data
According to the sparse data available, low testosterone levels are detected in around 20% of men under 60 and 30% of men under 70. Only 5% of those diagnosed had low testosterone and symptoms. So, you can begin to appreciate the difficulties in diagnosis.
Treatment
The reasons for treatment are two-fold. Firstly, for symptom relief and secondly to protect against consequences such as fractures, type II diabetes and metabolic syndrome (essentially a cluster of risk factors which leads to heart disease). Before drug treatment is considered, lifestyle changes need to be addressed. These include weight, exercise, smoking and alcohol etc.
Next non-medical therapies can be tried. These include B vitamins and Ashwagandha (a plant extract). Once these have been tried then TRT (testosterone replacement therapy) is considered.
This comes in the form if injection, tablets, gels or patches.
There are risks and side effects to the treatment including prostate and urinary issues, water retention, acne, mood changes, breast enlargement, hair loss and clot formation.
It can also interact with some other medications. It is for this reason that other forms of treatment are usually tried first in a risk vs benefit balance.
So, in conclusion. Andropause is a natural event in a man’s life cycle. It does not have the same public awareness as menopause. It is not as widely publicised, diagnosed or treated as menopause but its effects can be every bit as unpleasant and dangerous.
If you have questions about andropause after reading this blog, request a copy of our Andropause Checklist, either email hello@choosetonic.co.uk or use our Andropause Awareness Checklist
If you are concerned, then please either reach out to Tonic or discuss the issue with your GP.
