Andropause
Encyclopedia
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 cell
s.
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.
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.
. 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 syndrome
s.
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.
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.
The following treatments have been found to be effective. These include:
Selective androgen receptor modulator
s have also been proposed.
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
-like condition in aging men. This relates to the slow but steady reduction of the production of the hormones testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
and dehydroepiandrosterone
Dehydroepiandrosterone
5-Dehydroepiandrosterone is a 19-carbon endogenous steroid hormone. It is the major secretory steroidal product of the adrenal glands and is also produced by the gonads and the brain. DHEA is the most abundant circulating steroid in humans....
in middle-aged men, and the consequences of that reduction, which is associated with a decrease in Leydig cell
Leydig cell
Leydig cells, also known as interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testicle. They produce testosterone in the presence of luteinizing hormone...
s.
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
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
and its ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
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
Hypogonadism
Hypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...
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 testosteroneTestosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
has been previously reported. In 1944, Heller and Myers identified symptoms of what they labeled the "male climacteric
Climacteric (biology)
In current practice, climacteric is most often a synonym for female menopause. In Princeton University's online Wordnet database, climacteric is listed as: * climacteric...
" including loss of libido
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
and potency, nervousness, depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
, impaired memory, the inability to concentrate, fatigue, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
, 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
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
.
In one study, 98.0% of primary care physicians believed that andropause and osteoporosis
Osteoporosis
Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
risk were related.
The term "symptomatic late onset hypogonadism
Hypogonadism
Hypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...
" (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
Asymptote
In analytic geometry, an asymptote of a curve is a line such that the distance between the curve and the line approaches zero as they tend to infinity. Some sources include the requirement that the curve may not cross the line infinitely often, but this is unusual for modern authors...
(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 testosteroneTestosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
. This drop in testosterone levels is considered to lead in some cases to loss of energy and concentration, depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
, and mood swings
Mood Swings
Mood Swings is an album by Koby Israelite released in 2005 on Tzadik.- Track listing :# "Dror Ikra" - 3:03# "Return of the Idiots" - 2:19# "It Is Not a War Here" - 7:05# "Ethnometalogy" - 5:08# "Europa?" - 2:49# "Hiriya On My Mind" - 4:53...
. 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
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
men do not produce adequate testosterone, which leads to early andropause. In Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, 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
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, and genetic disorders that produce hypogonadism
Hypogonadism
Hypogonadism is a medical term for decreased functional activity of the gonads. Low testosterone is caused by a decline or deficiency in gonadal production of testosterone in males...
, including Klinefelter's
Klinefelter's syndrome
Klinefelter syndrome, 46/47, XXY, or XXY syndrome is a condition in which human males have an extra X chromosome. While females have an XX chromosomal makeup, and males an XY, affected individuals have at least two X chromosomes and at least one Y chromosome...
, Wilson-Turner, and Androgen insensitivity syndrome
Androgen insensitivity syndrome
Androgen insensitivity syndrome is a condition that results in the partial or complete inability of the cell to respond to androgens. The unresponsiveness of the cell to the presence of androgenic hormones can impair or prevent the masculinization of male genitalia in the developing fetus, as...
s.
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
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
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 therapyAndrogen replacement therapyAndrogen replacement therapy is a hormone treatment often prescribed to counter the effects of male Hypogonadism. It is also prescribed to lessen the effects or delay the onset of normal male aging...
- Exercise, dietary changes, stress reduction
Selective androgen receptor modulator
Selective androgen receptor modulator
Selective androgen receptor modulators or SARMs are a novel class of androgen receptor ligands. They are intended to have the same kind of effects as androgenic drugs like anabolic steroids but be much more selective in...
s have also been proposed.