Andropause

Andropause or male menopause, sometimes colloquially called "man-opause" is a name that has been given to a menopause-like condition in aging men. This relates to the slow but steady reduction of the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men, and the consequences of that reduction, which is associated with a decrease in Leydig cells.

Unlike women, middle-aged men do not experience a complete and permanent physiological shutting down of the reproductive system as a normal event. A steady decline in testosterone levels with age (in both men and women) is well documented.

Unlike "menopause", the word "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification. This is likely because "andropause" is a term of convenience describing the stage of life when symptoms of aging appear in men. While the words are sometimes used interchangeably, hypogonadism is a deficiency state in which the hormone testosterone goes below the normal range for even an aging male.

As a "state"
The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers 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 decreased dramatically when patients were given replacement doses of testosterone.

Andropause has been observed in association with Alzheimer's disease.

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

The term "symptomatic late onset hypogonadism" (or "SLOH") is sometimes considered to refer to the same condition as the word "andropause".

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 .) The "D" is sometimes given as "decline" instead of "deficiency". In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.

Proponents
Proponents of andropause as a distinct condition claim that it is a biological change experienced by men during mid-life, and often compare it to female menopause. Menopause, however, is a complete cessation of reproductive ability caused by the shutting down of the female reproductive system. Andropause is a decline in the male hormone testosterone. This drop in testosterone levels is considered to lead in some cases to loss of energy and concentration, depression, and mood swings. While andropause does not cause a man's reproductive system to stop working altogether, many experience bouts of impotence.

Andropause is usually caused by a very gradual testosterone deficiency and an increase in sex hormone-binding globulin (SHBG) that occurs from age 35 onwards. By contrast, women have a more rapid onset of menopause at an average age of 51. Testosterone declines 10% every decade after age 30 (1% per year).

Premature andropause can occur in males who experience excessive female hormone stimulation through workplace exposure to estrogen. Men who work in the pharmaceutical industry, plastics factories, near incinerators, and on farms that use pesticides are high-risk for early andropause.

By their mid-50s, about 30 percent of men experience andropause. About 5 million American men do not produce adequate testosterone, which leads to early andropause. In Australia, about 1 in every 200 men under the age of 60 and about 1 in every 10 men over 60 have low testosterone. Regardless of location, the most likely males to develop early andropause are those with diabetes, hypertension, and genetic disorders that produce hypogonadism, including Klinefelter's, Wilson-Turner, and Androgen insensitivity syndromes.

Some of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond, a lay person. According to Diamond's view, andropause 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. The term "male menopause" may be a misnomer, as 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 ). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.

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

Opponents
Many clinicians believe that andropause is not a valid concept, because men can continue to reproduce into old age. Their reproductive systems do not stop working completely, and therefore they do not exhibit the sudden and dramatic drops in hormone levels characteristic of women undergoing menopause. In some men before the age of 60 there is a complete loss of libido, erectile function, and orgasmic ability.

Others feel that andropause is simply synonymous with hypogonadism or low testosterone levels. There is opposition to the concept of andropause in Europe as well as the U.S.

Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition. For example, people who are overweight may be misguided into treating a new illness rather than addressing the lifestyle that led to their being overweight. Similarly, energy levels vary from person to person, and for people who are generally inactive, energy levels will automatically be lower overall.

While it is true that active and otherwise healthy men could in theory develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.

Suggestions for treatment
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.
 * Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise.
 * Diamond (a lay person) believes that depression is one of the most common problems of middle-aged men, and feels it is greatly under-diagnosed, sometimes with serious consequences.

The following treatments have been found to be effective. These include:
 * Hormone replacement therapy
 * Exercise, dietary changes, stress reduction

Selective androgen receptor modulators have also been proposed.