Andropause

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Abstract

Age-related decline in serum testosterone level may present as a constellation of signs and symptoms of hypogonadism known as andropause. However, low testosterone can also be indicative of an underlying pituitary disorder; therefore, careful workup should be performed to distinguish between benign and pathologic conditions in individual men. This article presents an overview of the etiology and pathophysiology of hypogonadism, and offers guidelines for the evaluation of men who should have further testing. The pros and cons of various testosterone formulations are discussed.

Introduction

Andropause is defined as an age-related decline in serum testosterone levels to below the normal range for young men that results in a clinical syndrome of androgen deficiency. The signs and symptoms of low testosterone in adult men include diminished libido, erectile dysfunction, decreased muscle mass and muscle strength, and decreased bone mass. Other symptoms may include decreased cognitive function and memory, depression, irritability, sleep disturbance, fatigue and hot flashes. This constellation of symptoms and signs may be present to a variable degree in individual men. There is controversy as to whether or not this is a physiologic adaptation to aging or a pathologic event. Andropause should not be viewed as a disease, but as a clinical syndrome.

Section snippets

Incidence and etiology of age-related hypogonadism

Serum testosterone levels begin to decline at approximately 30 years of age, with an approximate 1% decline yearly thereafter. In addition to the progressive decline in serum testosterone concentrations, the sex hormone binding globulin (SHBG) level progressively increases with age, resulting in a more pronounced decrease in free and bioavailable testosterone compared with total testosterone concentrations. The Baltimore Longitudinal Study of Aging conducted in 890 men 26–96 years of age

Evaluation of hypogonadism

An Andropause Consensus Conference was held in April 2000, which was sponsored by the Endocrine Society. Subsequently, recommendations for the evaluation of possible hypogonadism in adult men were published [5]. The recommendations included obtaining morning serum testosterone, LH and prolactin levels. A diagnosis of andropause may be considered if the serum testosterone level is below normal and the LH and prolactin levels are normal. However, in the instance of a patient with a normal or low

Testosterone therapy

Testosterone replacement may be beneficial in ameliorating the symptoms and signs of hypogonadism, and replacement therapy should be considered after a thorough evaluation to determine if there are any contraindications to treatment. Risks of testosterone replacement include exacerbation of benign prostatic hyperplasia (BPH), which is present in approximately 80% of men by the age of 80. Additional adverse consequences of testosterone therapy include worsening of sleep apnea, promotion of

Conclusions

The questions of how much evaluation of age-related hypogonadism is required and whom to treat are controversial. If the demographic information on the prevalence of hypogonadism in aging men is considered, then up to 70% of men over the age of 70 may be candidates for treatment. Only after careful evaluation and consideration of the risks and benefits should testosterone replacement be administered to older men. Gonadal steroid replacement in older men, as occurs in women, has some inherent

References (7)

  • J.E. Morley et al.

    Androgen deficiency in aging men: role of testosterone replacement therapy

    J. Lab. Clin. Med.

    (2000)
  • S.M. Harman et al.

    Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging

    J. Clin. Endocrinol. Metab.

    (2001)
  • J.M. Wishart et al.

    Effect of age on bone density and bone turnover in men

    Clin. Endocrinol. (Oxf.)

    (1995)
There are more references available in the full text version of this article.

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