Andropause
Conclusions
Current evidence supports the existence of progressive hypogonadism affecting many older men which has been labeled andropause or the ADAM syndrome. The diagnostic criteria for this syndrome, however, are imprecise because many of its symptoms, such as mood and energy level, are difficult to measure and separate from "normal" aging. In addition, possible changes in the androgen receptors with aging lead to uncertainty about the exact level of androgen required for optimum health. Also, many other hormone changes and disease states affect the aging man.
Nonetheless, testosterone appears to be a prominent hormone involved in this syndrome, and testosterone replacement in this population is used with increasing frequency. Androgen replacement should be instituted on the basis of the combination of low bone density or patient symptoms and low testosterone levels, and in the absence of other causes. A DRE (digital rectal examination) and PSA (prostate-specific androgen measurment) should be performed on all men prior to instituting testosterone replacement. Patients with known prostate or breast cancer (due to conversion to estrogen), abnormal DRE or elevated PSA or severe lower urinary tract symptoms are not suitable for testosterone replacement. Others will require careful follow-up to minimize the potential for long-term complications.
TROY SITLAND JOHN GRANTMYRE
See also HAIR; MENOPAUSE; PROSTATE; SARCOPENIA; SEXUALITY.
BIBIOGRAPHY
ABU, E.; HORNER, A.; KUSEC, V. et al. "The Localization of Androgen Receptors in Human Bone." Journal of Clinical Endocrinology and Metabolism 82 (1997): 3493–3495.
BEHRE, H.; KLIESCH, S.; LIEFKE, E.; LINK, T. ; and NIESCHLAG, E.. "Long-term Effect of Testosterone Therapy on Bone Mineral Density in Hypogonadal Men." Journal of Clinical Endocrinology and Metabolism 82 (1997): 2386–2390.
BHASIN, S.; STORER, T.; BERMAN, N. et al. "A Replacement Dose of Testosterone Increases Fat-free Mass and Muscle Size in Hypogonadal Men." Journal of Clinical Endocrinology and Metabolism 82 (1997): 407–413.
GOOREN, L. "The Age Related Decline in Androgen Levels in Men: Clinically Significant." British Journal of Urology 78 (1996): 763–768.
GRAY, A.; FELDHAM, H.; and MCKINLAY, J. "Age, Disease and Changing Sex Hormone Levels in Middle-aged Men: Results of the Massachusetts Male Aging Study." Journal of Clinical Endocrinology and Metabolism 73 (1991): 1016–1025.
JOCKENHOVEL, F.; VOGEL, E.; REINHARDT, W. et al. "Effects of Various Modes of Androgen Substitution Therapy on Erythropoiesis." European Journal of Medical Research 2 (1997): 293–297.
KATZNELSON, L.; FINKELSTEIN, J.; SCHOENFELD, D.; ROSENTHAL, D.; ANDERSON, E.; and KLIBANSKI, A. "Increase in Bone Density and Lean Body Mass During Testosterone Administration in Men with Acquired Hypogonadism." Journal of Clinical Endocrinology and Metabolism 81 (1996): 4358–4365.
MORALES, A.; HEATON, J.; and CARSON, C. "Andropause: A Misnomer for a True Clinical Entity." Journal of Urology 163 (2000): 705–712.
MORLEY, J.; PERRY, M.; KAISER, F. et al. "Effects of Testosterone Replacement Therapy in Old Hypogonadal Males: A Preliminary Study." Journal of American Gerontological Society (1993): 41.
NIESCHLAG, E. "Testosterone Replacement Therapy: Something Old, Something New." Clinical Endocrinology 45 (1996): 261–262.
PHILIPS, G.; PINKERNELL, B.; and JING, T. "The Association of Hypotestosteronemia with Coronary Artery Disease in Men." Arteriosclerosis and Thrombosis 14 (1994): 701–704.
SCHOW, D.; REDMON, B.; and PRYOR, J. "Male Menopause: How to Define It, How to Treat It." Postgraduate Medicine 101 (1997): 62–79.
SIH, R.; MORLEY, J.; KAISER, F. et al. "Testosterone Replacement in Older Hypogonadal Men: A 12-Month Randomized Controlled Trial." Journal of Clinical Endocrinology and Metabolism 82 (1997): 1661–1667.
SWERDLOFF, R. and WANG, C. "Androgen Deficiency and Aging in Men." Western Journal of Medicine 159 (1993): 579–585.
TENOVER, J. "Effects of Androgen Supplementation in the Aging Male." Journal of Clinical Endocrinology and Metabolism 75 (1992): 1092–1098.
TENOVER, J. "Androgen Administration to Aging Men." Endocrinology and Metabolism Clinic of North America 23 (1994): 877–892.
TENOVER, J. "Androgen Deficiency in the Aging Male." Aging Male 1 (supp. 1998): 16.
UYANIK, B.; ARI, Z.; GUMUS, B. et al. "Beneficial Effects of Testosterone Undercenoate on the Lipoprotein profiles in Healthy Elderly men, A Placebo Controlled Study." Japanese Heart Journal 38 (1997): 73–78.
VERMEULEN, A. "The Male Climacterium." Annals of Medicine 25 (1993): 531–534.
VERMEULEN, A. and KAUFMAN, J. "Ageing of the Hypothalamus-Pituitary-Testicular Axis in Men." Hormone Research 43 (1995): 25–28.
WANG, C.; ALEXANDER, G.; BERMAN, N. et al. "Testosterone Replacement Therapy Improves Mood in Hypogonadal Men—A Clinical Research Center Study." Journal of Clinical Endocrinology and Metabolism 81 (1996): 3578–3583.
WINKLER, U. "Effects of Androgens on Hemostasis." Maturitas 24 (1996): 147.
ZMUDA, J.; CAULEY, J.; KRISKA, A. et al. "Longitudinal Relation Between Endogenous Testosterone and Cardiovascular Disease Risk Factors in Middle-Aged Men. A 13-Year Follow-Up of Former Multiple Risk Factor Intervention Trial Participants." American Journal of Epidemiolofy 146 (1997): 609–613.
Additional topics
Medicine EncyclopediaAging Healthy - Part 1Andropause - Changes In The Aging Male, Complications Of Testosterone Replacement, Types Of Replacement Therapy, Conclusions