Andropause: The Change of Life in Men

Male menopause or Andropause (declining testosterone levels) is a distinct physiological phenomenon affecting men between 40 and 60 years old. Approximately 40% of men in this age range will experience some degree of symptoms including decreased libido and sexual function, irritability, depression, decreased motivation, increased body fat and fatigue.  The effects of low testosterone in men can cause significant health and psychosocial social issues so it is important to identify and treat andropause. As other diseases such as diabetes can also cause similar symptoms, a full heath evaluation and check up is necessary.

Factors which may contribute to declining testosterone levels, in addition to aging, include other hormonal deficiencies, high alcohol consumption, obesity, smoking, high blood pressure, poor diet, some medications and a mid-life depression. A mid life depression or crisis in men may occur after the long effort to succeed has resulted in stability, and the struggles that were once part of life have been overcome. This is a time of change, and may bring awareness that one phase of life has passed, and a redefinition of “self” is necessary. This is a psychosocial issue that is important to address to achieve optimal wellness for the next phase of life. To help cope with the inevitable change that life brings it is important to find effective ways of stress management. Eat a nutrient dense diet high in fruit, vegetables, whole grains and legumes and essential fatty acids. Quality sleep is important, as is regular exercise. Limiting alcohol and caffeine while assuring good hydration with water promote energy and mood. A multivitamin without iron may also be a good idea.

The St. Louis ADAM (Androgen Deficiency in the Aging Male) questionnaire asks the following questions: (1) Decrease in sex drive. (2) Lack of energy. (3) Decrease in Strength and/or endurance. (4) Lost Height. (5) Decreased “enjoyment of life”. (6) Sad and/or grumpy. (7) Erections less strong. (8) Deterioration in sports ability. (9) Falling asleep after dinner. (10) Decreased work performance. Men experiencing problems 1, 7 or a combination of any four or more should consult with their physician whether or not they are candidates for testosterone replacement therapy (TRT).

Testosterone is a powerful substance and needs to be prescribed and used carefully. A risk benefit analysis will be performed by your physician. If you have prostate cancer you are not a candidate for TRT, as it can aggravate an already existing tumor.  Other contraindications to TRT may include sleep apnea, cardiovascular disease or BPH. Topical preparations of testosterone are now available to deliver steady dosing and avoid the complications associated with oral ingestion or the need to take shots. Talk to your doctor about whether or not andropause is an issue for you.

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