Andropause

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Andropause (sometimes called male menopause^[1]) refers to a reduction of the production of certain hormones (such as testosterone and dehydroepiandrosterone, and the consequences of that reduction.^[2] It is associated with a decrease in Leydig cells.^[3][4]

The use of the term "andropause" is not in itself controversial, and the term appears frequently in peer-reviewed journal articles, both with and without scare quotes. The controversy, rather, is over whether andropause is a "state" (the term used by MeSH), or a "disorder". The decline in testosterone level with age is well documented,^[5] but there is disagreement over how the "normal" or "healthy" state should be defined. Researchers who oppose the term "andropause" usually don't object to the terms "SLOH" or "ADAM", described in more detail below.

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Andropause as a "state"

The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers^[6] identified symptoms of what they labeled the "male climacteric" including loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. Heller and Myers found that their subjects had lower than normal levels of testosterone, and that symptoms improved dramatically when patients were given replacement doses of testosterone.

Andropause has been observed in association with Alzheimer's disease.^[7]

In one study, 98.0% of primary care physicians believed that andropause and osteoporosis risk were related.^[8]

The term "symptomatic late onset hypogonadism" (or "SLOH") is sometimes considered to refer to the same condition as the word "andropause".^{[9] [10]}

Some researchers prefer the term "androgen deficiency of the aging male" ("ADAM"), to more accurately reflect the fact that the loss of testosterone production is gradual and asymptotic (in contrast to the more abrupt change associated with menopause.)^[11] The "D" is sometimes given as "decline" instead of "deficiency".^[9] In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.^[12]

Andropause as a "disorder"

Proponents

Its proponents claim that it is a biological change experienced by men during their mid-life, and is often compared to female menopause. While menopause relates to a cessation of reproductive ability, andropause refers to a diminishment of the key male hormone testosterone which can lead to a severe loss of energy, concentration and depression, mood swings resulting in uneccessary nastiness and spiteful behaviour towards others. Unlike menopause, andropause does not necessarily cause a man's reproductive system to stop working altogether in mid-life but most will experience bouts of impotence.

Some of the current interest in andropause has been fueled by the book Male Menopause, written by Jed Diamond.^[13] According to Diamond, andropause (another term for "male menopause") is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, generally between the ages of 40 and 55, though it can occur as early as 35 or as late as 65. Some argue the term "male menopause" is a misnomer, as men don’t have menstrual periods, and therefore cannot stop having them. Unlike women, men's reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives (at age 90 or older^[14]). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.^[15][16][17]

The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.^[18]

Opponents

In the U.S., many clinicians believe that, since men can continue to reproduce into old age, and do not universally show the same dramatic drops in hormone levels characteristic of menopause in women, andropause is nonexistent. Others feel that andropause is real, synonymous with hypogonadism or low testosterone levels.^[17] Opposition is not limited to the US.^[19]

The role of hormones, generally speaking, is an unsettled area of science. Some argue that many of the cited symptoms are not specific enough to warrant describing a new condition as the cause. People who are overweight may be misguided into treating a 'new illness' rather than addressing the lifestyle that lead to being overweight. Similarly, energy levels vary naturally, and for those who are inactive, they are lower overall.

While it is true that active and otherwise healthy men might develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, continues to be studied.

Unlike menopause, the term "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification.

Diagnosis

Although there is disagreement over whether or not andropause is a condition to be "diagnosed" and "treated", those who support that position have made several proposals to address andropause and mitigate some of its effects.

• Morley emphasizes the importance of response to treatment, as well as testosterone level and identifiable symptoms.^[20]

• Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise. ^[21]

• Diamond believes that depression is one of the most common problems of men going through andropause, and feels it is greatly under-diagnosed in men, with serious consequences.^[22]

Treatment

Several intervention strategies have been found to be effective.^{[13] [16] [22] [18]} These include:

• Hormone replacement therapy^[23]

• Exercise, dietary changes, stress reduction ^[23]

• Couple counseling, career refocusing, and spiritual support^{[citation needed]}

• Chemical dependency treatment, sexual compulsivity treatment^{[citation needed]}

• Treatment for depression^{[citation needed]}

• Finding and engaging one’s “calling” in the second half of life^{[citation needed]}

Selective androgen receptor modulators have also been proposed.^[24]

References

See also

• Irritable Male Syndrome