Andropause - Lack of Testosterone

While men get older, their testosterone levels begin to decrease. This fall is often called andropause, in analogy to the menopause of women. The negative consequences of low testosterone in andropause, however, are less evident than those of estrogen reduction in menopause.

Unlike menopause, in which estrogen deficiency is complete and causes known clinical changes, such as osteoporosis, vaginal dryness, loss of skin elasticity, etc., the decline of testosterone in older men is modest and the possible consequences have not yet been well established.

Elderly man
Elderly man

What is hypogonadism?

Male hypogonadism is a condition in which the testis does not produce enough levels of testosterone, the hormone that plays a key role in male growth and development during puberty.

Hypogonadism can be caused by genetic diseases, poor formations of the testicles or the pituitary gland (gland inside the central nervous system that controls the production of hormones in the body), infections such as mumps, trauma to the testicles , use of drugs or medicines, among others.

When hypogonadism occurs in the fetus, there are malformations of the genitalia. When it occurs in pre-teens, the patient does not develop the typical signs of male puberty, such as body hair, voice change, muscle gain, enlargement of the testicles and penis, etc. In young adults, hypogonadism causes infertility, decreased libido, hair loss, loss of muscle mass, and other symptoms of testosterone deficiency.

In this text we are going to focus on the hypogonadism that comes with aging, called late male hypogonadism or andropause. Hypogonadism of the elderly is completely different from what occurs in younger men.

Andropause symptoms

Testicular function and testosterone production decline progressively with age, the latter at about 1.3% per year after age 40. A substantial proportion of men over the age of 50 have testosterone levels low enough to diagnose hypogonadism. It is worth noting that a slight testosterone deficiency in middle-aged men can be considered a natural phenomenon of aging. The point is to know when this deficiency becomes clinically relevant.

Unlike hypogonadism in infants, children and young adults, declining testosterone in older men does not produce any really clear consequence. However, although there is no unequivocal evidence, andropause is currently attributed to some consequences of aging in males, among them:
  • Reduction of libido
  • Erectile dysfunction
  • Loss of bone mass (osteoporosis)
  • Reduction of muscle mass and strength
  • Increased percentage of body fat
  • Mood changes
  • Memory changes
  • Decreased performance at work

The problem is that not all of the changes described above improve with testosterone supplementation and many of these can also occur in the elderly without andropause criteria.

Treatment of andropause

Although there are scientific papers suggesting that declining testosterone with age may have several negative consequences, the impact of testosterone replacement on older men remains unknown.

What is currently accepted, in the light of current knowledge, is that testosterone replacement may be beneficial in selected patients. International Endocrinology societies currently indicate testosterone therapy only in elderly patients with low testosterone levels - less than 200 ng / dL, measured at two or three different times in the morning - and important symptoms of testosterone deficiency. Testosterone is not indicated for the elderly with vague and non-specific symptoms.

The replacement can be done orally, injected or through adhesives or skin creams.

Adverse effects of testosterone replacement

As there is little evidence that testosterone replacement in late male hypogonadism brings real benefits and there are risks of significant adverse effects, treatment should only be done by specialists and under close supervision.

Among the risks of testosterone replacement, the most feared is the increased incidence of prostate cancer. There are no scientific studies that prove the safety of testosterone replacement in relation to prostate cancer, so no long-term replacement is indicated. Rectal examination of the prostate and measurement of blood PSA are important before planning hormone treatment.
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