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PubMed2005

[Andropause].

The terms andropause, partial androgen deficiency of the aging male (PADAM) or late-onset hypogonadism (LOH) describe a clinical entity which has been defined as a syndrome associated with advanced age. This syndrome is characterised by a deficiency in serum testosterone levels that may result in significant alterations in the quality of life and adversely affect the function of multiple organ systems. Whereas in classic primary and secondary hypogonadism, the clinical picture of testosterone deficiency is clearly defined, the clinical diagnosis of PADAM might escape detection for various reasons: not all signs and symptoms necessarily present together; they often progress slowly and are subtle in nature; the non-specific signs and symptoms might not be discernible from the unavoidable process of aging itself. However, PADAM features many potentially serious consequences that can be avoided or treated, and is, therefore, clinically relevant. Testosterone substitution may be an effective way to manage this condition. Once patients begin treatment with testosterone substitution, follow-up and monitoring are essential.

Age Factors↗
PubMed2005

Dysregulation of the hypothalamic-pituitary-gonadal axis with menopause and andropause promotes neurodegenerative senescence.

Senescence is characterized neurologically by a decline in cognitive function, which we propose is the result of degenerative processes initiated by the dysregulation of the hypothalamic-pituitary-gonadal (HPG) axis with menopause and andropause. Compelling epidemiologic evidence to support this assertion includes the increased prevalence of Alzheimer disease (AD) in women, the correlation of serum HPG hormones with disease and the decreased incidence, and delay in the onset of AD following hormone replacement therapy. Dysregulation of the axis at this time leads to alterations in the concentrations of all serum HPG hormones (decreased neuronal sex steroid signaling, but increased neuronal gonadotropin releasing hormone, luteinizing hormone, and activin signaling). Hormones of the HPG axis, receptors for which are present in the adult brain, are important regulators of cell proliferation and differentiation during growth and development. Based on this, we propose that dysregulated HPG hormone signaling with menopause/andropause leads to the abortive reentry of differentiated neurons into the cell cycle via a process we term "dyosis." Interestingly, the major biochemical and neuropathologic changes reported for the AD brain also are intimately associated with neuron division: altered AbetaPP metabolism, Abeta deposition, tau phosphorylation, mitochondrial alterations, chromosomal replication, synapse loss, and death of differentiated neurons. Recent evidence supports the premise that AD-related biochemical changes are likely the combined result of increased mitotic signaling by gonadotropins and GnRH, decreased differentiative and neuroprotective signaling via sex steroids, and increased differentiative signaling via activins. This results in a hormonal milieu that is permissive of cell cycle reentry but does not allow completion of metaphase. Partial resetting of the axis following administration of normal endogenous sex steroids delays the onset and decreases the incidence of AD. Ideally, supplementation with HPG hormones should mimic closely the serum concentrations of all HPG hormones in reproductive men and cycling women to prevent dyotic signaling and attempted neuron division.

Adult↗
PubMedDate not supplied

Andropause: an emerging world health problem.

Andropause is an emerging clinical concept that is gaining an increasing recognition, as the world becomes more aging. The clinical features though subtle are easy to identify and appropriate treatment of diagnosed cases will to a goodextent alleviate a lot of age-related complaints and improve the general quality of life in the elderly men. Low level of clinical suspicion secondary to inadequate knowledge about this clinical entity remains the major obstacle to appropriate treatment. In this review, the literature has been perused and the definition, epidemiology, pathophysiology, clinical features, diagnosis and treatment are outlined.

Aging↗
PubMed2004

[Are age and educational level the determinants of hormonal parameters considered as indices of andropause?].

The involutionary processes in gonadal and adrenal glands are significant for male aging. The dynamics of hormonal changes in aging men seems to be individually differentiated and vary in distinct populations. Currently there are no data on social differences in hormonal parameters in men. The study was carried out in order to evaluate the age-related changes of hormonal parameters considered as indices of andropause and analyze the social gradients in these variables in healthy Polish men. Material comprised the data of 414 healthy men, inhabitants of Wrocław, aged 32-79, examined in 2000 in DOLMED (Wrocław, Lower Silesia). Serum levels of the following hormones were assessed using radioimmunological assays: free testosterone (FT), total testosterone (TT), estradiol (E2), dehydroepiandrosterone sulphate (DHEAS), luteinizing hormone (LH), sex hormone binding globulin (SHBG) and insulin-like growth factor 1 (IGF-1). The following indices were calculated: FAI (Free Androgen Index), TT/E2 and TT/LH. Among Polish men there were negative correlations between age and serum levels of FT, DHEAS, IGF-1, E2, and between age and FAI, TT/LH. The correlation between the DHEAS level and age was the strongest among all relationships here. The male aging was accompanied by the serum reduction, during 5 years: FT level of 4.8%, DHEAS--8.6% and IGF-1--5.0%. The reduction in serum DHEAS and IGF-1 levels reached 77.3% and 44.9% (respectively) between men aged 32-34 and the oldest subjects aged 75-79. The decrease in serum FT level between men aged 32-34 and those aged 70-74 was 38.2%. The relationships between age and E2 level and between age and TT/LH were not strong (respectively, beta = -0.10, p < 0.05 and beta = -0. 17, p < 0.001). The male aging was also accompanied by the increase in serum SHBG (11.7%/5 years) and LH levels (13.5%/5 years). Among male there were no age-related changes in the serum TT level and TT/E2. The results of a two-way ANOVA revealed that education significantly differentiated serum IGF-1 levels (independently on age). The highest IGF-1 levels were observed in men who had graduated from university, the lowest--in those who had finished the trade school at the very most. In contrast, there were no social differences in other analysed hormonal parameters.

Adult↗
PubMed2003

Role of androgens in mild cognitive impairment and possible interventions during andropause.

Mild cognitive impairment (MCI) is becoming fashionable as a diagnosis, representing a state of cognitive decline associated with negligible functional loss. MCI is important as it often precedes Alzheimer's disease (AD). Recognizing MCI may lead to preventive strategies that can delay the onset of AD. Many patients who transition into andropause report problems with their memory. There is strong evidence from basic sciences and epidemiological studies that both estrogens and androgens play a protective role in neurodegeneration. The evidence from small prospective clinical trials lends support to the role of hormones in improving cognitive function. The improvement in cognitive function with hormones is subtle and often not measurable on standard neuropsychological batteries. Patients have reported memory improvements in both declarative and procedural domains after being on hormonal replacement. Functional changes and vascular changes can be detected after hormonal replacement with more sophisticated imaging of the brain like positron emission tomography (PET) scans. We hypothesize androgens and perhaps selective androgen receptor modulators as future treatment options for MCI in aging males.

Aging↗
PubMed2004

Role of androgens in mild cognitive impairment and possible interventions during andropause.

Mild cognitive impairment (MCI) is becoming fashionable as a diagnosis, representing a state of cognitive decline associated with negligible functional loss. MCI is important as it often precedes Alzheimer's disease (AD). Recognizing MCI may lead to preventive strategies that can delay the onset of AD. Many patients who transition into andropause report problems with their memory. There is strong evidence from basic sciences and epidemiological studies that both estrogens and androgens play a protective role in neurodegeneration. The evidence from small prospective clinical trials lends support to the role of hormones in improving cognitive function. The improvement in cognitive function with hormones is subtle and often not measurable on standard neuropsychological batteries. Patients have reported memory improvements in both declarative and procedural domains after being on hormonal replacement. Functional changes and vascular changes can be detected after hormonal replacement with more sophisticated imaging of the brain like PET scans. We hypothesize androgens and perhaps selective androgen receptor modulators as future treatment options for MCI in aging males.

Aging↗
PubMed2003

An integrative review on current evidence of testosterone replacement therapy for the andropause.

OBJECTIVES: This paper examines the evidence supporting testosterone replacement in aging males. Confounding factors contributing to low testosterone levels and challenges to diagnosis of the andropause will also be considered. METHODS: A thorough review using an integrative approach citing published literature and the ongoing work of the authors. A search was performed using National Library of Medicine PubMed. Electronic and print journals available at the Texas Medical Center library were also considered. RESULTS: Information based on collective trials in older men has added to evidence for benefits and side effects of testosterone replacement inferred from studies in younger hypogonadal patients and animal models. In general, most investigators agree with short-term safety but long-term safety is unknown. Testosterone therapy in aging males improves body composition, certain domains of brain function and may also decrease cardiovascular risk in biological models. Measurable clinical effects are less apparent. Potential risks include erythrocytosis, edema, gynecomastia, and prostate stimulation. The possibility of increased risk of clinically significant prostate cancer and cardiovascular disease has been considered. CONCLUSION: The search continues for an ideal replacement androgen and larger long-term studies are needed. At this time, androgen replacement is on a case-by-case basis and prostate cancer screening should be completed prior to instituting therapy. Routine androgen replacement therapy for aging males will have significant economic implications, and is not currently recommended.

Aging↗
PubMed2003

Andropause: an old concept in new clothing.

There is increasing evidence that the common condition of hypogonadism in older men when associated with symptoms responds well to testosterone replacement. Over the last few years there has been a marked increase in the awareness and treatment of the andropause [137]. Long-term side effects of testosterone are uncertain with only eight people over 50 years having been studied for 10 years [138]. Testosterone needs to be considered a quality-of-life drug, similar to sildenafil, and at present it should be used only if it produces symptomatic improvement. There is a need for a men's health study to determine the long-term efficacy and safety of testosterone replacement in older persons.

Aged↗
PubMed1998

Male hormone replacement therapy including "andropause".

Adult onset male hypogonadism and the testosterone deficiency of the aging male often are under-recognized entities. The etiologies, presentation, and diagnosis of hypogonadism and andropause in the adult male are presented. The expected therapeutic goals, potential treatment risks, and management of androgen replacement therapy for the adult man are reviewed. The advantages and disadvantages of the various androgen delivery systems currently available and under investigation are discussed.

Adult↗
PubMed2003

Andropause.

Age-related decline in serum testosterone level may present as a constellation of signs and symptoms of hypogonadism known as andropause. However, low testosterone can also be indicative of an underlying pituitary disorder; therefore, careful workup should be performed to distinguish between benign and pathologic conditions in individual men. This article presents an overview of the etiology and pathophysiology of hypogonadism, and offers guidelines for the evaluation of men who should have further testing. The pros and cons of various testosterone formulations are discussed.

Aging↗
PubMed2003

[Menopause, andropause and sexual function].

After about fifty years of age, at the time of the menopause and the andropause (androgenic deficiency), men as well as women can have the same type of complaint, but it is facing time that women have a different view from men. Time is coded into a woman's body, whereas it is by 'social' time that men are more often determined. On the sexual level there is a slow-down in the sexual reactions of both men and women. One should not forget, however, that the cure for sexual problems in women sometimes involves the treatment of male sexual dysfunction (erection problems, premature ejaculation, absence of ejaculation). Therapeutically, hormonal replacement therapy is undoubtedly a help, if there are no medical contra-indications and if the patient is in agreement. If the complaint is also sexual then a more specific, therapeutic treatment may often be necessary, associating hormone treatment with erection inducers.

Aging↗
PubMed2002

Male andropause: myth, reality, and treatment.

A progressive decrease in androgen production is common in aging men. The physiological causes for this phenomenon seem to be multifactorial. The magnitude of the decline in testosterone with age and the prevalence of older men with low testosterone levels have not been well established. The extent to which an age-dependent decline in androgen levels leads to health problems that might affect or alter the quality of life remains under debate. In men older than middle age, total testosterone levels may be misleading because of an increase in sex hormone-binding globulin levels. The mechanism of the age-associated decrease of the endocrine testicular function is also essentially due to primary testicular failure, but important changes occur at the hypothalamopituitary level. The most prominent endocrinological alterations with aging are related to the sex steroids, but others, such as growth hormone, melatonin cortisol, and thyroxine, are also affected. The clinical picture of andropause syndrome is characterized by diminished sexual desire and erectile capacity, decrease in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density that results in osteoporosis, and increase in visceral fat and obesity. Current medical treatments for androgen supplementation include oral tablets, intramuscular injections, and scrotal and nonscrotal patches. Unfortunately, none of these preparations mimic the circadian rhythm, even if some of them may approximate the circadian rhythm by dose adjustments. Moreover, the androgen supplementation could have adverse effects on different organs, namely, the liver, lipid profile, cardiovascular disease, prostate, sleep disorders, and emotional behavior. Clinical response is a better guide to dose requirements, regardless of serum testosterone levels. This important field must be actively investigated by the medical, behavioral, and social sciences.

Climacteric↗
PubMed2003

Andropause: an androgen deficiency state in the ageing male.

An age-related decline in circulating testosterone levels has been shown to occur in the adult male population starting as early as middle age and continuing on into old age. This decline in testosterone has been associated with a number of changes in body composition and sexual performance in the male that are directly attributable to an androgen deficiency state, which can be restored by the use of testosterone replacement therapy. The term 'andropause' has been used to describe this gradual drop in testosterone in the ageing male and is characterised by different endocrine, somatic and psychic changes that become more pronounced as the male gets older. For some males, the adjustment of circulating testosterone levels with replacement therapy to levels seen in young men can improve physical performance, induce a sense of well-being and restore the androgen-dependent sex drive that declines with ageing.

Aged↗
PubMed1982

Andropause: incidence and pathogenesis.

One hundred forty-five male volunteers, 60 to 91 years old, without any hepatic, renal, or metabolic pathology, and not under any steroid therapy for at least 1 year were studied. Plasma luteinizing hormone (LH), Follicle Stimulating hormone (FSH), Testosterone (T), 17-beta-Estradiol (E2), Androstenedione (A), Maximal increase (MI) of LH and FSH after luteinizing hormone releasing hormone (LHRH) (50 gamma iv), and pulsations (P) of LH and FSH over a 3 hr period were measured by radioimmunoassay (RIA). The patients were divided in four groups according to LH and T levels. Group I: (46% of our subjects) showed no signs of hypogonadism with normal LH, T, E2, A, MI of LH and FSH, and normal P-LH, P-FSH. Group II: (15%) with high LH but normal T, showed high FSH, MI-LH, MI-FSH, P-LH, and P-FSH, but normal A and E2. Group III: (22%) with classical signs of hypergonadotropic hypogonadism (high LH and low T) showed high FSH, MI-LH, MI-FSH, and P-FSH, normal P-LH and E2, but low A. Group IV: (16.5%) with signs of hypogonadotropic hypogonadism (low LH and low T) had also low MI-LH, MI-FSH and A, but normal FSH, P-LH, P-FSH, and E2. Contrarily to menopause in women, andropause is not an obligatory event in men, and when it does occur, its pathogenesis and hormonal aspects are very variable.

Aged↗
PubMedDate not supplied

Andropause and the aging male.

For many years andropause has been compared to female climaterium. Data show that symptoms are more an identification process with the climateric partner. Sexual function decreases with age but hormonal changes are not the major determining factor in this decline. There is histological evidence of an aging testicle, with reduced number of Leydig and Sertoli cells. Testosterone also declines about a third, as do dehydroepiandrosterone, dehydroepiandrosterone sulfate, prolactin, growth hormone, and insulin growth factor-1. There is no change in dehydrotestosterone and estrogens and there is an increase in follicle stimulating and luteinizing hormones levels. Recent data cannot recommend the use of hormone replacement therapy with androgens because of potential severe side effects and lack of data on long-term effects.

Aging↗
PubMed2004

Is it andropause? Recognizing androgen deficiency in aging men.

In primary care practice, it is not unusual to encounter male patients in their 50s or older who report having loss of libido, erectile dysfunction, fatigue, and depression. Such signs and symptoms may signal an age-related decline in androgen levels, which commonly begins after age 40. However, psychologic problems and medical illness often confound the diagnosis. Drs Tan and Pu, who are currently conducting research on androgen deficiency, discuss the diagnostic difficulties of the physiologic phenomenon of andropause and offer a comprehensive approach to clinical assessment and laboratory evaluation.

Aging↗
PubMed1999

[Testosterone and atherosclerosis in males during andropause].

Nowadays besides the commonly accepted atherogenic risk factors a special emphasis is laid on the significance of testosterone in atherogenesis in men which physiologic deficit during "andropause" is able to promote this pathology. An elevated estradiol:testosterone ratio seems to be an independent risk factor of atheromatous heart complications. There is a proved positive correlation between free testosterone, total testosterone, dihydrotestosterone and HDL-cholesterol, apoA1 apolipoprotein. The relationship between LDL-cholesterol, VLDL-cholesterol, total cholesterol and total and free testosterone seems to be unanimous, but in certain studies the beneficial influence of testosterone on the mentioned lipids has been observed. The discussed hormone is also functionally connected with coagulation and fibrynolisis; a positive correlation was found between endogenous testosterone and tPA-Fx and a negative correlation between testosterone and PAI-1, fibrinogen, D-dimers, alpha 2-antiplasmin. Testosterone is a functional regulator of the vascular tonus and influences on reological properties of microcirculation (the application of testosterone infusion into canine coronary arteries causes the dilatation of main and the small vessels, through NO syntetase induction and ATP-dependent K(+)- channel activation). A statistically significant positive correlation between testosterone and insulin has been stated (an elevated oestradiol:testosterone ratio is connected with the insulin resistance). Additionally a negative relationship between testosterone and android obesity has been observed. Although nowadays there are more and more facts proving the benefits of the retaining the proper testosterone levels in aging men, the final influence of the testosterone supplementary therapy on atherogenesis is not solved.

Adult↗