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
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