Andropause is a condition caused by a decrease in the male hormone known as testosterone. Andropause or late-onset hypogonadism is a common disorder which increases in prevalence with advancing age.
Hormonal changes are a natural part of ageing for both men and women. Women experience more dramatic plunge of sex hormones with cessation of menstruation, rendering a drastic emergence of certain associated menopausal symptoms. However, for men the decline in testosterone production tends to have an insidious onset and slower progress. The testis, unlike the ovaries, do not run out of the substance it needs to make testosterone. Healthy men may be able to make sperm well even at much later age. There is a subtle changes in the function of the testis occur as early as the age 40 to 50 and more dramatically after the age of 70 in some men. This prompted the debate whether andropause is real of just a myth.
Diagnosis of andropause is based on presence of symptoms suggestive of testosterone deficiency such as loss of libido, early morning woods and erectile dysfunction with demonstration of low testosterone level on blood test. However, there is much variability to the testosterone level and its impact on different individual. Some men may have lower than normal levels of testosterone without any adverse symptoms.
Among signs and symptoms of andropause are:
- Loss of libido
- Decrease or loss of spontaneous erection and morning wood or difficulty to achieve erection (erectile dysfunction)
- Low energy and fatigue
- Depression, irritability
- Poor concentration
- Decrease motivation and self-confidence
- Reduced muscle mass and strength
- Increase abdominal fat ('beer belly')
- Penile or testicular shrinkage
- Breast enlargement ('man boobs')
- Height loss, low trauma fracture and osteoporosis
- Sleep disturbance (difficulty to fall asleep or sleeping too much)
- Slow beard growth or loss of body's hair
- Hot flushes
Testosterone affect various physical, psychological and sexual aspect of a man’s life. Various unhealthy lifestyle practices such as smoking, excessive alcohol consumption, overeating, lack of exercise, obesity and excessive stress level is generally associated with premature ageing in men and the early onset of andropause. Studies have shown that the early onset of andropause is strongly associated with development of metabolic syndrome (central adiposity, hypertension, dyslipidaemia, diabetes and insulin resistance) which increases risk of heart attack in the future.
If you are experiencing symptoms and signs of andropause, your doctor will perform full hormonal assessment to check for other causes of hypogonadism such as testicular failure from genetic disorder, previous testicular injury or infection, haemochromatosis, issue with the pituitary or hypothalamus, use of medication (steroid) or organ failure (liver and kidney disease). Your doctor will also perform measurement of your waist line, weight and BMI, blood pressure as well as checking your sugar and lipid profile.
If there is biochemical evidence of low testosterone together with symptoms, your doctor will start you on testosterone replacement therapy. Risks and benefits of TRT will be discussed thoroughly beforehand with stringent monitoring of the efficacy and for adverse reaction of TRT.
It is very important to start making healthy lifestyle changes such as weight reduction if overweight and obese, regular exercise including cardio and strength training, eating healthy and balanced meals, quit smoking, cutting down on alcohol consumption and reducing stress level. This should be the long term goal for prevention and treatment of andropause and other serious health issue related to it. Take time to 'pause' and pay more attention to your health today. If you have any further questions about andropause and men's health, come and talk to our doctor for consultation.