What is Andropause?
“Doctor, is it possible that I am changing? I have always worn 34″ pants but in the last few years the size has increased, I just bought 38s and they’re tight. My get up and go, got up and left and now you want to start me on blood pressure medication and something for cholesterol. My once strong upper body has dropped to my belly and worst of all my… well, let’s just say I need some Viagra.” Welcome to Andropause!
Sound familiar? As men age, they change and that change starts in their early teens with facial hair increased libido, and increased lean muscle mass. We all accept this as normal and attribute it to the production of testosterone. The second change is not so abrupt but rather a slow decline. For most, it starts at thirty with a slow decrease in testosterone as well as DHEA and HGH (human growth hormone). Very minimal effects are seen but by mid-forties, the changes are more obvious. These changes continue for the rest of their lives, which could mean 40-plus years. This is andropause. That’s forty years of declining quality.
Testosterone Production
Testosterone is produced for the most part from the leydig cells located in the testicles. When the messenger from the brain sends down a message, called LH, our Leydig cells respond by making testosterone. This testosterone then shuts of the LH until the testosterone level drops and more is required.
Production increases at puberty and is responsible for what we call secondary sex characteristics. We associate this with increased lean muscle mass, libido, and a decrease in body fat.
At the age of thirty, we begin to see the first signs of a decrease in the production of testosterone but the drop occurs very slowly – the beginning of andropause. The number used most commonly is 1.5% a year. We don’t see significant changes in the thirties in the majority of cases but there are exceptions. In the forties, we see the changes that we associate with getting older. Drop lean muscle mass, that spare tire, and drop in energy and libido
Effects of Andropause
With the drop in testosterone, we begin to see men’s visits to their physicians increase. This is the time that men develop what are commonly referred to as age-related diseases. Some examples are type 2 diabetes, hypertension, elevated cholesterol, and ultimately heart disease and increased risk of stroke. We also have a drop in bone density, a loss in muscle mass, a loss of memory, and a disturbance in our sleep patterns.
Benefits of Testosterone
- Testosterone has multiple benefits to men’s health
- Increased bone mineral density
- Increased insulin sensitivity
- Increase lean muscle mass
- Increased energy
- Improved sleep
- Increased memory and concentration
- Improvement in dyslipidemia
- Feeling of well-being
- Decreased incidence of prostate cancer
- Endothelial regeneration
- Reversal of atherosclerotic plaque
- Increased coronary blood flow
- Increased libido
- Decrease in visceral fat
Testosterone Replacement
Once the decision is made that testosterone replacement is indicated the decision becomes what route? There are multiple routes available from pellets implanted under the skin to weekly injections done into the muscle to creams or gels applied to the skin. Once the patient is started on the replacement he will need to be monitored every quarter checking different blood tests. These tests include but are not limited to a total and free testosterone level, CBC, estradiol Dihydrotestosterone, and PSA. Andropause can be effectively treated with testosterone replacement therapy.
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