What is Andropause?

Andropause is also known as ADAM (Androgen decline in the aging male) . It is a phenomenon on similar to menopause except that:

• it occurs more gradually,
• no clear cut sign (e.g. menses stop in menopause) and a decline in testosterone hormone (oestrogen in female)

What is testosterone hormone?

• Testosterone is produced in the testis by special cells.
• It determines and shapes the male reproductive organ, development of body hair and male pattern baldness.
• Testosterone is necessary for normal sex desire, ejaculation and spontaneous erection.

How common is Andropause?

Andropause is fairly a common condition

Occurrence in male is estimated to be :

• 2% – 5% at the age of 40 – 49
• 6% – 30% at the age of 50 – 59
• 20% – 45% at the age of 60 – 69
• 34% – 70% at the age of 70 – 79
• 91% in man above 80

How do I know that I am experiencing andropause?

Andropause produces a variety of changes to man’s body which includes :

Not all men will experience the same degree of these symptoms, and some men may not have any symptoms at all.

• Problem with erections
• Low sex drive
• Mood changes eg. feeling tired, irritable, depression, anger
• Sleep difficulty
• Decrease in body hair
• Loss of muscle size and strength
• Increased body fat
• Memory loss
• Osteoporosis (Bone thinning)
• Unable to concentrate

What are the tests if I want to know my status?

• Blood test can be done for Serum testosterone in the hospital.
• If the level is less than 200ng/dL the man is considered as having low testosterone.
• If the level is greater than 600ng/dL, low testosterone can be ruled out.

What is hormone replacement therapy?

Andropause can be treated with Testosterone Hormone in the form of :

Once started, it should be maintained for life.

• Oral tablet
• Injections
• Long acting slow release pellet
• Patches
• Gels

What evaluation should be done before starting on HRT?

Evaluation needs to be done before starting on HRT :

Testosterone stimulates prostate growth and make any existing prostate cancer worse. Therefore PSA need to be done before starting HRT and 6 monthly after that.

• Baseline urologic examination
• Blood test- Prostate specific Antigen (PSA)
• Lipid profile
• Liver function test
• Full blood count/Haematocrit

What are the side effects of HRT?

Men with breast cancer and prostate cancer are not suitable for HRT as testosterone will make both this cancer grow more rapidly.

Other side effects :

• Leg swelling, worsening of high blood pressure
• Liver problems
• Fertility problem – shuts down sperm production.
• Sleep problem such as breathing stops for a period of time while sleeping
• Breast enlargement
• Increased red blood cell concentration
• Increase in prostate size

How effective is HRT?

Testosterone replacement therapy may improve bone mass, muscle mass, strength and nocturnal erection. However the effect on sexual function and mood is still unclear but may be useful to some men.

What will the doctor do during follow up?

You need to have a regular follow up so that your doctor can monitor you in terms of :

• Testosterone dosage
• Side effects
• Regular blood test

Where can I get help?

If you think that you have Andropause symptoms, you can see health care professionals (Government health clinic, LPPKN clinic, FPA clinic ) for advise and assessment. You may be referred to Urology clinic if HRT is required.

References

• http://andropausespecialist.com/
• http://www.testosterone-fertility.com/andropause.html
• Malaysian Clinical Practice guideline in Erectile Dysfunction 2003