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 is increasing, 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, lets just say I need some viagra.” Welcome to andropause!
Sound familiar? As men age, they definitely change and that change starts in their early teens with facial hair increase libido and increased lean muscle mass. We all accept this as normal and attribute it to 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-fories 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 increase lean muscle mass, libido, and decrease in body fat.
At the age of thirty we begin to see the first signs of decrease in production in 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 thiries in the majority of cases but there are exceptions. In the forties we really 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 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, 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 decsicion 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 on a quarterly basis checking differnet 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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