Andropause : what is it? Symptoms & treatments

Andropause is defined as the set of physiological and psychological symptoms that can accompany the drop in testosterone in aging men . It would usually occur around 45 to 65 years old .

These symptoms range from decreased sexual appetite to the onset of erectile dysfunction to feeling low on energy and energy. Periods of excessive sweating, problems with insomnia and weight gain could also add to the repercussions of a decline in sex hormone production.

Seen as a dysfunction by some, as a reflection of normal aging by others, andropause remains a controversial subject . What’s more, the only drug available, testosterone, has not been proven, either in terms of efficacy or safety.

Menopause for some, andropause for others?

The comparison between andropause and menopause is rather lame. Andropause only affects a minority of men. Also, it does not mark the end of fertility. In addition, the hormonal decline in men is partial , gradual and inconstant , unlike women, in whom hormones drop markedly over a short period of time. In men, a slight drop in testosterone production would start in their thirties or forties. From what experts have observed, the concentration of testosterone in the blood will decrease by about 1% per year.

How many men affected?

Since andropause is little known and rarely detected, exact data are not available on the proportion of men who suffer from it.

However, according to a large study published in 2010, the European Male Aging Study, only 2% of men aged 40 to 80 experience andropause: the proportion is 3% in those aged 60 to 69 and 5% among those aged 70 to 79 1 . The diagnosis was based on the presence of symptoms of andropause and a lower than normal blood testosterone level.

According to the study authors, these results indicate that testosterone treatment is suitable for very few men 12 . Most of the time, according to their observations, the symptoms are more related to aging, obesity or another health problem. Indeed, 20% to 40% of men would develop symptoms that may resemble those of andropause with age 11 .

Really a question of testosterone?

The testosterone is available as a treatment for the andropause for a little over a decade. The goal of treatment is to improve the quality of life by reducing symptoms. Pharmaceutical companies argue that testosterone could also delay the aging process  : less loss of muscle mass and risk of fractures, more sexual vigor, including better erections, etc. However, these effects have not been scientifically demonstrated.

Here are the main factors that make the treatment of andropause a delicate and complex subject:

  • The level of testosterone that reflects “deficiency” in middle-aged men is unknown. In addition, this rate varies from man to man. The scales currently in use have a significant degree of imprecision and are based on averages established for young men;
  • There are no symptoms specific to andropause. In other words, all the symptoms experienced can be the consequence of other health problems, such as depression, vascular problems or obesity;
  • The association between low testosterone and symptoms of andropause is weak, according to various studies. Men with normal testosterone levels may experience symptoms of andropause. Some experts believe that andropause symptoms are more often the result of poor lifestyle habits 2 , 11 ;
  • The benefits and risks of testosterone treatment have not been clearly established by clinical trials, both short and long term. Some experts claim that hormone therapy with testosterone is an expensive placebo 12 . The main fear associated with this treatment in older men is to increase the risk of prostate cancer or stroke.. This is because testosterone increases hemoglobin levels and can slightly alter the lipid profile in the blood, increasing the risk of a blood clot forming in an artery in the brain. Other risks mentioned include: liver damage, breast development (which can become painful), testicular atrophy, increased aggressive or antisocial behavior and worsening of an existing health disorder (sleep apnea, mania, depression, etc. etc.). Like hormones prescribed to postmenopausal women, it may be discovered in retrospect that this testosterone treatment presents certain health risks. Studies are in progress;
  • Other hormonal changes could explain the effects of andropause. DHEA (dehydroepiandrosterone), growth hormone, melatonin and, to a lesser extent, thyroid hormones also exert their influence.
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Testosterone

Testosterone is the predominant sex hormone in men. It is associated with vitality and virility. We owe him the appearance of male sexual characteristics at puberty. It also helps maintain bone health and muscle firmness and stimulates the production of sperm and red blood cells. The way fat accumulates in the body is also influenced by this hormone. Women also produce it, but in very small quantities.

The testes make testosterone. The amount of testosterone produced depends on signals sent by glands located in the brain: the hypothalamus and pituitary. Various factors will promote or inhibit the production of testosterone. Sex, for example, stimulates her. Once produced, testosterone travels through the bloodstream and binds to receptors in various tissues, where it exerts its effects.

Diagnostic

Since the treatment of andropause is recent, the criteria leading to the diagnosis do not have a solid scientific basis.

The doctor first inquires about the symptoms felt by his patient. He may use certain assessment forms to better portray the intensity of symptoms, such as the AMS test (for Aging Male Score ) or the ADAM test (for Androgen Deficiency of the Aging Male ). To view these tests, see the Sites of interest section.

This is a good opportunity to establish a complete health check-up  : blood tests (lipid profile, thyroid hormones, specific prostate antigen, etc.), portrait of cardiovascular health, overview of lifestyle habits. A list of drugs and natural health products consumed will complete the picture. This assessment will help to exclude other possible causes of the symptoms felt (anemia, depression, hypothyroidism, chronic fatigue syndrome , blood circulation problems, side effects of drugs, etc.).

Blood tests

Here are some explanations about the tests that are used to assess whether there is a testosterone deficiency.

According to the International Society for the Study of Aging Male (ISSAM), tests to measure blood testosterone levels should be part of the diagnosis since symptoms may not be related to andropause 3 . But these tests are done only if more than one symptom is manifested.

  • Total testosterone levels. The result of this test includes both testosterone bound to a transporter (the sex hormone binding globulin or SHBG and, to a lesser extent, albumin) and testosterone which circulates freely in the blood;
  • Free testosterone levels. This measurement is important since it is free testosterone that is active in the body. On average, about 2% of testosterone circulates freely in the blood. There is no test that directly measures the level of free testosterone. Doctors therefore estimate by calculation: they measure the level of sex hormone binding globulin (SHBG) in the blood and then subtract it from the level of total testosterone.
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Symptoms of andropause

In some men, various symptoms could be explained by a decrease in testosterone production 3 . At the moment, the ones that seem most clearly related to testosterone levels are the following 3 symptoms 11  :

  • Decreased sexual appetite;
  • Less frequent morning erections;
  • The inability to have an erection and maintain it properly during intercourse.

Other symptoms often associated with andropause:

  • Heat;
  • A significant drop in energy and fatigue;
  • A wave of depression;
  • Insomnia;
  • Slight problems with memory and concentration;
  • Generalized physical discomfort, lack of physical strength;
  • An increase in visceral (abdominal) fat.

Andropause – People at risk and risk factors

People at risk

We still know too little about andropause to determine whether some men are at greater risk.

Risk factors

These factors have been associated with lower testosterone 9 :

  • Excessive consumption of alcohol and marijuana;
  • Extra weight. An increase of 4 or 5 points in body mass index would be equivalent to an aging of 10 years relative to the drop in testosterone 10 ;
  • Abdominal obesity. It corresponds to a waist circumference greater than 94 cm (37 in) in men;
  • Diabetes and metabolic syndrome;
  • Blood lipid levels, especially cholesterol, outside normal values;
  • Chronic illness;
  • Liver problems;
  • Chronic stress;
  • Taking certain medications, such as antipsychotics, certain antiepileptics and narcotics.

Prevention of andropause

Can we prevent?
To some extent, the impact of symptoms could be reduced by adopting a healthy lifestyle , since this influences testosterone levels.For example, to maintain or help restore good erectile function, nutritionist Hélène Baribeau makes the following suggestions:moderate alcohol consumption;reduce the consumption of salty foods;consume more omega-3s (salmon, sardines, flax seeds, etc.);eat more dietary fiber;avoid very sweet foods.

Medical treatments for andropause

Clinics specializing in andropause have emerged in recent years. If andropause is diagnosed, hormone therapy with testosterone is sometimes prescribed. It is the only drug treatment currently available.

In the United States, the prescription of testosterone has increased 20 times over the past 20 years 11 .

However, if erectile dysfunction is the main symptom, taking a phosphodiesterase type 5 inhibitor (Viagra®, Levitra®, Cialis®) is often considered first. Depending on the case, a consultation with a psychologist or a sex therapist may be beneficial. See also our Male Sexual Dysfunction sheet .

In addition, the doctor will carry out a check-up, as the symptoms could be explained by a medical condition or an illness that has not yet been diagnosed. Weight loss, if indicated, and improvement in lifestyle habits should be favored before starting testosterone hormone therapy.

Testosterone hormone therapy

From what doctors observe in the clinic, some men would benefit from this treatment. This is because hormone therapy with testosterone may increase libido , improve the quality of erections, increase energy levels and strengthen muscles . It could also contribute to better bone mineral density . It may take 4 to 6 months before the therapeutic effects of testosterone are fully manifested 13 .

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It is not known, however, whether hormone therapy with testosterone poses any long-term health risks . Studies are in progress. A potentially increased risk is mentioned:

  • benign prostatic hyperplasia ;
  • prostate cancer;
  • breast cancer;
  • liver problems;
  • sleep apnea;
  • blood clots, which increases the risk of having a stroke .

This treatment is contraindicated in patients with uncontrolled heart disease, uncontrolled hypertension, prostate disorder or high hemoglobin level .

As a precaution, prostate cancer screening tests are done before starting hormone therapy, and then on a regular basis thereafter.

Methods of administration of testosterone

  • The transdermal gel. The gel (Androgel®, concentrated at 2% and Testim®, concentrated at 1%) is the product most often chosen, because it is quite easy to use while providing a more stable testosterone level than tablets and injections. It is applied daily to the lower abdomen, upper arms or shoulders, to clean, dry skin for maximum absorption (after a morning shower, for example). We must then wait 5 to 6 hours before wetting the skin, while the drug is absorbed. Be careful, however, the medication can be transmitted to the partner by skin contact;
  • Transdermal patches. The patches also allow a very good absorption of the drug. On the other hand, they cause skin irritation for half of the people who try them, which explains why they are used less than the gel 14 . A patch should be applied once a day to the trunk, stomach or thighs, each evening, varying the sites from one time to another (Androderm®, 4.8 mg per day);
  • Tablets (capsules). Tablets are more rarely used because they are less convenient to use: they must be taken a few times a day. In addition, they have the defect of providing a variable level of testosterone. One example is testosterone undecanoate (Andriol®, 120 mg to 160 mg per day). Some forms of testosterone tablets present a risk of liver toxicity;
  • Intramuscular injections. This is the first mode of administration to enter the market. It remains the least expensive, but requires going to the doctor or a clinic to receive the injection. For example, cypionate (Depo-Testosterone®, 250 mg per dose) and testosterone enanthate (Delatestryl®, 250 mg per dose) should be injected every 3 weeks. Some people can now give the injections on their own.

Our doctor’s opinion on andropause

It would be really nice to have a “treatment” to lessen the signs and symptoms of normal aging . It would be nice if I could take a product that would improve my muscle mass and performance. A lot of athletes are doing it and it seems to be working! On the other hand, the price to pay is a whole host of known and unknown short, medium and long term disadvantages.

It is likely that a very small proportion of middle-aged men actually suffer from andropause and that testosterone treatment will help them. I am of the opinion that for the moment, caution is in order. We haven’t found the fountain of youth yet.

There is currently too little scientific data on this subject. Much more research is needed on the long-term effects of testosterone use for andropause. When this research is completed, we will really know the pros and cons of this treatment. Only then will men be able to make an informed decision.

Careful follow-up by a caring and knowledgeable physician seems essential to me for anyone who uses a testosterone supplement.

Complementary approaches to andropause

No specific complementary approach has been studied or recommended by our sources.

Caution. Self-medication with products that contain testosterone is not recommended. Taken by mouth, testosterone can be toxic to the liver. Since the quality of products found on store shelves or on the Internet varies enormously, the actual dose of testosterone in each tablet is often unknown.

Several plants have been used, traditionally, to try to alleviate the loss of desire and erectile dysfunction. Examples include tribulus, yohimbe, and maca.