Andropause: Understanding male menopause

Andropause, often referred to as male menopause, is a condition associated with a decline in testosterone levels in aging men. Unlike menopause in women, which occurs relatively quickly when the ovaries stop producing hormones, andropause is a more gradual process that can extend over many years.

What is andropause?

Andropause is characterised by a decline in testosterone, the primary male sex hormone, and can lead to a variety of symptoms. It typically affects men between the ages of 40 and 60, although it can start earlier or later. The term "andropause" is somewhat controversial as it implies a direct correlation with menopause, which is not entirely accurate given the differing mechanisms and symptoms.

Causes of andropause

The primary cause of andropause is the natural decline in testosterone production with age. Several factors contribute to this decline:

1. Aging: Testosterone levels naturally decrease by about 1-2% per year after the age of 30.
2. Health conditions: Conditions like obesity, diabetes, and chronic illnesses can exacerbate the decline.
3. Lifestyle factors: Poor diet, lack of exercise, excessive alcohol consumption, and smoking can contribute to lower testosterone levels.
4. Medications: Certain medications, especially those used to treat chronic diseases, can affect hormone levels.

Symptoms of andropause

The symptoms of andropause can vary widely among individuals and may include:

Physical symptoms:

• Decreased muscle mass and strength Increased body fat
• Reduced bone density
• Fatigue and decreased energy levels
• Hot flashes and sweating

Sexual symptoms:

1. Reduced libido
2. Erectile dysfunction
3. Decreased sexual satisfaction

Emotional and psychological symptoms:

• Mood swings
• Depression
• Irritability
• Difficulty concentrating and memory problems

Diagnosing andropause

Diagnosing andropause involves a combination of symptom assessment and laboratory tests. Doctors typically look for the following: 

1. Symptom assessment: A comprehensive evaluation of the patient's symptoms and medical history.
2. Blood tests: Measuring testosterone levels through blood tests. These tests are often conducted in the morning when testosterone levels are at their peak.
3. Additional tests: Other hormone levels, such as luteinising hormone (LH) and follicle-stimulating hormone (FSH), may also be measured to rule out other conditions.

Treatment options

Treatment for andropause aims to alleviate symptoms and improve quality of life. Options include:

Lifestyle changes:

• Regular exercise
• Healthy diet
• Adequate sleep
• Stress management

Hormone replacement therapy (HRT):

• Testosterone replacement therapy can be administered through injections, patches, gels, or tablets.
• Regular monitoring is necessary to adjust dosage and check for side effects.

Medications:

• Medications to treat specific symptoms such as erectile dysfunction (e.g., sildenafil).

Psychological support:

• Counselling or therapy to address mood swings, depression, and other psychological symptoms.

Risks and considerations

While testosterone replacement therapy can be effective, it is not without risks. Potential side effects include:

• Increased risk of heart disease
• Prostate enlargement
• Sleep apnoea
• Skin reactions

It is crucial for patients to discuss the benefits and risks with their healthcare provider to make an informed decision.