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Andropause A Mid-Life Hormone Crisis


Written by Dr. Welsh, Published on 19 August 2014

Andropause FAQ

What is Andropause?

Andropause is a medical state that is a natural result of aging, in which symptoms of aging manifest resulting from a decline in Testosterone Production and other male hormones such as dehydroepiandrosterone, also referred to as DHEA.

Andropause is a universal factor of the male condition, although each male will physiologically react to the condition in their own way, and some men will display symptoms much earlier than others.

How Fast do Testosterone Levels Decline Over Time?

From the age of puberty to around the late twenties, males are flush with Testosterone, which contributes to optimal health and wellness. Around the late twenties or early thirties, however, these levels start to drop, at a rate of around 1%-2% per year. This decline is slow and without symptoms at first, but as the decline becomes more severe, the changes start to become apparent.

How Can I Qualify for Andropause Treatment?

In order to be prescribed Testosterone Treatment for Andropause, or other effective treatments, you must undergo clinical evaluation. Many men have Low Testosterone without displaying symptoms. In order to qualify for Low-T treatment, you must not only have clinically low levels of Testosterone, but you must also display symptoms of the condition.

There are many conditions which may prevent you from qualifying for treatment, including prostate cancer and severe sleep apnea.

What Blood Tests Are Necessary In Order to Diagnose Andropause?

Although your doctor may order a variety of tests in order to fully assess your overall health and hormone balance, for Age-Related Low-T, the most important test is the Free Testosterone Test. Free Testosterone is also referred to as Bioavailable Testosterone, and refers to the amount of Testosterone that is available for use by the body, and not currently being used.

With a saliva or blood sample, it is possible to take a snapshot of your current Free Testosterone Levels.

What is Total Testosterone?

Total Testosterone refers to all Testosterone that is circulating through your blood stream. This includes both Free (Bioavailable) Testosterone and bound Testosterone.

Why Is the Total Testosterone Test Insufficient for the Diagnosis of Andropause?

The vast majority of patients with Symptomatic Andropause have clinically normal Total Testosterone Levels, meaning that if Total Testosterone alone is evaluated, most patients with Andropause will appear to have normal Testosterone Levels, because the wrong factor is being measured. Recent research has shown that among men with Andropause, only 13% show depressed Total Testosterone Levels, whereas nearly three out of four of those patients had Low Free Testosterone Levels.

Because many physicians only measure Total Testosterone when evaluating Andropause, symptoms of Testosterone Deficiency are often diagnosed mistakenly as resultant from chronic fatigue, stress, depression, and other factors. Many of the treatments for these conditions actually have a depressant effect upon Testosterone, which could actually exacerbate symptoms in the long run.

By Fifty, What Percentage of Men Have Abnormally Low Free Testosterone Levels?

Among men over fifty, it is approximated that roughly half of men have Free Testosterone Concentrations that would be considered clinically low for men between the ages of thirty and forty.

What Are Other Names for Andropause?

Andropause is often referred to by a number of different names. For the sake of simplicity, it is often referred to in the media as Low-T, although Low-T is a broader term which simply refers to any physiological state in which Testosterone Levels are inadequate to meet the needs of the body. Another informal term for Andropause is Manopause, used to further emphasis the physiological connection between Menopause and Andropause.

Andropause is also sometimes referred to as Age-Related Testosterone Deficiency, which is a more adequate representation of the condition, because Andropause is an age-dependent chronic condition. Other similar names include Partial Androgen Deficiency in Aging Males, Androgen Deficiency of the Aging Male, and Symptomatic Late Onset Hypogonadism.

Because Andropause has not been fully accepted as a medical condition by the World Health Organization or the Food and Drug Administration, there is not a codified set of terms related to the condition, although there is a large amount of on-going study, and the condition is widely recognized by medical professionals and medical research institutes both nation- and worldwide.

What Causes Andropause?

Andropause is caused by a combination of hereditary factors and lifestyle choices, also known as Internal and External Causes. Internal causes are genetic.

Before Andropause occurs, the body enters a state of Hypogonadotrophic hypogonadism. During this period, the body produces less Testosterone than is produced by younger, healthier men. Hypogonadotrophic hypogonadism is a state in which the brain does not respond adequately to signals that Testosterone Levels are insufficient to promote the optimal health of the human body. Hypogonadotrophic hypogonadism generally takes place around the age of forty.

Testosterone production will continue to decline over time, eventually to a point at which the pituitary and the hypothalamus respond by producing elevated concentrations of Gonadotropin-Releasing Hormone and Luteinizing Hormone in an effort to rebound declining Testosterone. This is effective for a brief period of time, but the body eventually reverts to a state of decline once again.

This is the period at which Andropause takes place. Hypogonadotrophic hypogonadism refers to the early state at which GnRH and LH Levels are low in combination with Testosterone. Andropause refers to the period at which Testosterone Production remains inhibited in spite of increased LH and GnRH levels.

This hormonal change is absolutely normal, in that it is a natural progression of male hormone balance, which bears some similarities to menopause, hence the name. One significant way that Andropause and Menopause differ is that there is more variation as to when men begin to experience their change. Women will reach menopause at some point between the early 40s and late 50s, whereas some men will begin to experience symptoms before or even after that period.

What Are Lifestyle Factors Which Encourage Symptoms of Andropause?

Although the human body has a baseline of Testosterone Production dependent on age and genetics, this production can be affected by lifestyle choices which further suppress Testosterone Levels in the body. The following are some factors which can inhibit the body's natural ability to release Testosterone:

  • Inadequate Sleep

  • Poor Diet

  • Sedentary Lifestyle

  • Medications

  • Overindulgence of Alcohol

  • Stress

  • Illness

What Are the Symptoms of Andropause?

Andropause is a complex condition which affects male health in a wide variety of ways. The following are some symptoms associated with Age-Related Testosterone Deficiency:

  • Insomnia

  • Head and Back Aches

  • Reduced Sex Drive

  • Depression

  • Mood Instability

  • Hot Flashes

  • Hypersensitivity

  • Irritability

  • Social Withdrawal

  • Anger

  • Unhealthy Changes in Body Composition

  • Fatigue

  • Loss of Bone Mineral Density

What Are Some Effective Andropause Treatments Available?

Men with Andropause can benefit significantly from Hormone Replacement Therapy. There are a number of options available to Andropause patients, including:

  • Testosterone Patches

  • Testosterone Creams

  • Testosterone Gels

  • Injectable Testosterone (Testosterone Enanthate, Testosterone Cypionate, etc.)

  • Testosterone Pellet Therapy

  • Clomiphene Citrate

What is the Difference Between Andropause and Primary Testosterone Deficiency?

Most men suffering from symptoms related to Andropause have perfectly functioning testes, but do not receive sufficient signaling from the hypothalamus to produce enough Testosterone to meet the needs of the body.

Andropause is a form of secondary hypogonadism related to age. The older that men get, the less efficient that their bodies are at producing Testosterone. Primary Testosterone Deficiency is Low-T that is the result of a direct malfunction of the testes which prevents the body from being able to produce Testosterone at normal levels.

Both of these forms of Testosterone Deficiency can be treated with Bioidentical Testosterone Therapy, but there are more off-label options available to patients that suffer from Andropause and other forms of Secondary Hypogonadism, such as Clomiphene Citrate.

Testosterone production is actually the result of a cascade of signals that begins at the hypothalamus. The hypothalamus releases a hormone known as gonadotropin-releasing hormone (GnRH), which circulates to the pituitary, stimulating the production of Follicle-Stimulating Hormone and Luteinizing Hormone, which both contribute heavily to the healthy function of the male reproductive system. Luteinizing Hormone stimulates the production of Testosterone and other male sex hormones, while Follicle-Stimulating Hormone promotes the healthy production of sperm.

What Are Some Health Risks Associated with Andropause?

Andropause is correlated with a number of health conditions which can severely impact health and wellness, including:

  • Diabetes

  • Hypertension

  • Obesity

  • Chronic Fatigue

  • Heart Attack

  • Stroke

There is even evidence that Andropause leads to an increased risk of Alzheimer's and other neurological disorders.

What is the Goal of Andropause Treatment?

The ultimate goal of Andropause Treatment is not to flood the body with Testosterone, but simply to restore Testosterone Levels in the body to normal, physiological levels. In general, Testosterone Replacement Therapy Treatments aim to restore Testosterone Concentrations to what would be considered mid-normal for a man in his twenties.

In restoring Testosterone Levels to these physiologically normal levels, it is possible to significantly mitigate the symptoms of Andropause, helping men live healthier lives.

What Are the Benefits of Andropause Treatment?

  • Higher Quality of Life

  • Fewer Mood Swings

  • Reduced Irritability and Anxiety

  • Preserved Bone Mineral Density

  • More Energy

  • Enhanced Muscle Health

  • Increased Metabolism

  • Improved Capacity to Burn Fat

  • Increased Libido

There is preliminary evidence that shows that Testosterone Treatment also improves cardiovascular health, but more research is needed.

Does Andropause Treatment Cause Cancer?

There is no evidence that Testosterone Therapy for Andropause causes cancer, but the treatment can exacerbate existing forms of cancer, including breast and prostate cancer, and should not be prescribed to individuals that have or are at high risk of these or other forms of cancer.

How Can I Treat Infertility Related to Andropause?

Unfortunately, Testosterone alone is not capable of restoring fertility. This is because Bioidentical Testosterone actually suppresses the ability of the testes to produce Testosterone and sperm for the duration of therapy. This is temporary, and testosterone production will return after therapy has been suspended, but for patients interested in having children, Testosterone Treatment alone will not be sufficient.

Testosterone can, however, be combined with Human Chorionic Gonadotropin (HCG) in order to simultaneously increase Testosterone Concentrations in the body while simultaneously preserving fertility and the normal function of the Testes. In the male body, HCG acts as a functional analogue of Luteinizing Hormone, both preserving the body's ability to make some of its own Testosterone while also preserving the fertility of the patient.

Clomiphene citrate (brand name: Clomid) is sometimes prescribed to men with Testosterone Deficiency/Andropause that are interested in Testosterone Restoration which also preserves fertility. Clomiphene increases Testosterone and Sperm Production by inhibiting negative feedback mechanisms which can limit the healthy production of Testosterone.

Is It Possible to Use Erectile Dysfunction Medications During Andropause Treatment?

Yes, but you may not have to in the long run. Andropause is one of the main causes of Erectile Dysfunction as men grow older, and many men with Age-Related Testosterone Deficiency report that as a result of Testosterone Replacement Therapy, they no longer rely as heavily on Erectile Dysfunction Medications. Many patients even report that they no longer need to use such medications.

There is research that shows that taking Erectile Dysfunction medications with Testosterone Therapy has the ability to resolve ED issues in 95% of patients.

What Are the Potential Side-Effects of Testosterone Therapy for Andropause?

As with any form of medical treatment, there are risks associated with Testosterone Restoration. The following are some of the risks associated with Andropause Treatment:

  • Oily Skin, increased prevalence of acne

  • Male-Pattern Baldness

  • Headaches

  • Prolonged/Frequent Erections

  • Gynecomastia (increased breast tissue can be treated with estrogen-blockers such as Arimadex)

  • Increased Red Blood Cell Count (can be treated via blood donation)

  • Accidental long term overdose can lead to Heart Disease

All patients that take Testosterone will experience the following symptoms resulting from therapy:

  • Reduced Fertility

  • Testicular Shrinkage

These symptoms are temporary, and will slowly return to a normal state after treatment has ended. Combining Testosterone with HCG can prevent these symptoms, as can Low-T Treatment with clomiphene citrate.

How Can I Mitigate the Effects of Andropause Through Lifestyle?

What Should I Avoid the Onset of Andropause Symptoms?

Stop Smoking and Using Tobacco Andropause has a negative impact on cardiovascular health, and smoking only exacerbates the risk of cardiovascular complications. Also, smoking reduces normal erectile function because nicotine encourages vasoconstriction, which reduces the ability of the body to rush blood flow to the potential erection.

Don't Abuse Alcohol Alcohol promotes the body's production of estrogen, which depresses testosterone production. Also, alcohol reduces zinc levels in the body, which reduces the ability of the body to adequately control estrogen production.

What Should I Do to Delay the Onset and Severity of Andropause Symptoms?

Lose Weight Adipose body fat has the natural ability to promote elevated estrogen levels which suppress testosterone production in men. By losing weight, it is possible to promote a healthier testosterone balance.

Eat Healthier Your body also needs a well-rounded diet rich in nutrients in order to promote optimal hormone balance and mitigate the effects of Andropause. Although the body needs some fat, diets that are high in fat will expose the body to more estrogen. Also, organic foods can help improve Testosterone levels, because many common pesticides have estrogenic qualities. Finally, a diet rich in cruciferous vegetables such as cauliflower and broccoli promotes healthy testosterone balance as a result of naturally occurring antioxidant compounds such as indole-3-carbinol.

Make a Concerted Effort to Improve Sleeping Habits The body produces Testosterone primarily at night. By taking the steps to make sure that you get all the sleep your body needs, you protect your body's natural ability to produce Testosterone.

Take Zinc Supplements Zinc is a very important nutrient which promotes the body's ability to produce its own Testosterone while also inhibiting the body's ability to produce estrogen and other aromatase compounds which suppress Testosterone production.

Manage Stress More Effectively In order to promote healthy Testosterone Production, it is important to control one's stress. Stress increases the production of cortisol, which is another cholesterol-based hormone. The body has a limited amount of these resources, and if you have too much stress, your body will divert resources from Testosterone production to Cortisol production.

What is the Average Dosage for Testosterone Restoration for Andropause?

When men are in their twenties, they generally produce between four and seven milligrams of Testosterone. Because not all Testosterone is absorbed during topical Testosterone Therapy, the initial dosage is generally between ten and twenty milligrams each day in order to bring Free Testosterone Production back to normal.

Because of potential issues related to elevated Testosterone Levels, it is prudent to start with a small dose in order to provide benefits with the lowest risk of side effects. Generally, patients will stay on this starter dose for around three or four months, then come back for further evaluation. Their dose will remain the same or be adjusted based on further testing as well as an evaluation of the effectiveness of treatment.

References:

Andropause: The Male Menopause

http://www.bodylogicmd.com/for-men/andropause

Frequently Asked Questions about Andropause (Male Menopause) and Testosterone Replacement Therapy

http://www.apothecaryoptions.com/pdf/atrfaq.pdf

Wikipedia: Andropause

http://en.wikipedia.org/wiki/Andropause





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