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PubMed2000

[Towards a consensus regarding androgen substitution therapy for andropause].

"Andropause" or "male climateric" refer to the term "menopause" in the women. The parallelism between both entities is however only partial since the decrease of gonadal function in the male is very different from one individual to the other. Some men present a gonadal deficiency together with an increase gonadotropin function as early as in the 40s while others show normal testicular function at 80 or later! It appears that besides genetic factors many life events (stress, obesity, sedentarity...) can "precipitate" testicular failure. Besides the major symptoms of sexual impotency and loss of libido, testosterone deficiency also induces reversible modification in lipid profile, muscle strength, bone density ... and on some cognitive and psychological parameters. It is therefore reasonable to treat androgen deficiency in early or late aging provided a cautious urological check-up has been realized before treatment. The mode of administration (i.m., p.o., or transdermal) will depend on the principal goal of the treatment and on the wish of the patient! An annual clinical and biological urological assessment is mandatory.

Aged↗
PubMed2002

[Andropause and its management in the aged male].

THE "ANDROPAUSE": Also called the "male menopause" or "partial androgen deficiency of the aging male" etc., corresponds to the age at which the progressive decrease in androgen activity reaches a pathogenic threshold. Surveys made in various countries since the seventies conclude that testosterone blood levels start to decrease after the age of 25 and that 20 to more than 50% of the male population no longer benefit from optimal androgen stimulation after the age of 60. THE CONSEQUENCES OF HYPOANDROGENISM: The subsequent progressive hypoandrogenism participates in inducing the commonly-observed clinical symptoms (fatigue, morosity, weight loss, lack of interest in sexual activity); the most specific of which is the disappearance or rarification of "automatic" nocturnal or matinal erections. This appears to influence the prostatic pathology and the frequent cardiovascular risk factors, which, far more than a problem of erection, is a major public health issue. A COMPLEX BIOLOGICAL DIAGNOSIS: Added to the abnormalities in production and transport of testosterone are the abnormalities in its metabolisation by the target tissues. These abnormalities are often undetected in present day blood controls and may explain the elevation in the hepatocyte of SHBG synthesis, the relative inhibition of GnRH pulses and LH secretion in the hypothalamus and the pituitary gland and, in the arterial wall (including penile vascularisation) and the prostate, some of the frequent functional and histological disorders. In current practice today, the best approximation of androgen potential is obtained by the comparison of total testosterone concentrations and SHBG, measurements that require relatively reliable standardised kits. THERAPEUTIC CHOICE: Optimal replacement therapy, for some authors, must mimic the physiology of the young man and above all maintain or reinforce the estrogenic effects of testosterone, related to its aromatisation into estradiol and supposedly beneficial for the cardiovascular system and the bone. For other, the androgenic effects, enhanced by the 5 alpha reduction into dihydrotestosterone (DHT), should be reinforced in older men because the estrogenic effects are ineffective on bone and most of the other targets, and are probably pathogenic for the prostate. This debate is extremely important since the various formulations of androgens authorized by the French Medicines agency (AFSSAPS) induce clearly differing estradiol/DHT plasma ratios.

Adult↗
PubMed2003

The endocrinology of gonadal involution: menopause and andropause.

Most aging individuals die from atherosclerosis, cancer or dementia. In the oldest old also loss of muscle strength resulting in frailty becomes the limiting factor for an individual's chances of living an independent life until death. Two hormonal changes mark the aging process in man. In women an acute drop in estrogen production by the ovaries around the age of 50 initiates a symptom complex called menopause. In men a more subtle drop of testosterone bioactivity from 40 yrs onwards might be accompanied by more difficulty to recognize symptomatology (andropause). Hormone replacement strategies in elderly women and males with estrogens or androgens, respectively, has some clear advantages, but is currently controversial, because of the occurrence of adverse effects.

Adult↗
PubMed2004

Testosterone replacement in men with andropause: an overview.

Serum testosterone levels decline progressively as men age, with resulting pathophysiological changes. Because the onset of andropause is gradual and many of its symptoms mirror those associated with medications or disease states common in the elderly, a clinical diagnosis can be difficult to make. Additionally, because of a lack of established normal testosterone levels for different age groups, as well as confusion regarding what subset of testosterone to measure, simply testing testosterone levels is inadequate. Although clinical studies have shown testosterone supplementation to be safe, no long-term placebo-controlled trials have been performed. Among the possible side effects of testosterone replacement therapy is an increased risk of prostate cancer. While there is no evidence that supplemental testosterone will initiate prostate cancer or cause clinically significant progression of an established occult malignancy, the initial evaluation of patients prior to administration of testosterone requires screening for prostatic carcinoma. A number of formulations of testosterone are currently available; transdermal gels, although expensive, are the preferred modality because of their ease of administration.

Journal Article↗
PubMedDate not supplied

[Clinical andropause].

A group of 43 male patients aged between 50 and 67 years with the symptoms of andropause in presented. The patients were divided into three groups depending on the degree of the symptoms. Such a classification may facilitate a choice of therapeutical methods.

Aged↗
PubMed2004

Climacteric medicine: European Menopause and Andropause Society (EMAS) statements on postmenopausal hormonal therapy.

Hormonal therapy (HT) is one of the most frequently prescribed drug regimens for women after the age of 50 years. HT has been developed progressively since the 1960s to provide estrogen to those women (a) who require relief of symptoms which have resulted from reduced circulating estrogen or (b) to act as an anti-resorptive agent to counteract the effect of the increased bone turnover which occurs with falling menopausal estrogen levels and which results in loss of bone mass leading to postmenopausal osteoporosis. However, a large number of women pass through the menopausal transition without experiencing distress as a result of the natural fall in estrogen hormone levels and since the introduction HT has been thought to be associated with a number of health benefits that have been tested in clinical trials but not substantiated. In women experiencing distressing climacteric symptoms double-blind randomised controlled clinical trials with a variety of HT regimens have shown that HT of any type provides symptom relief with no alternative treatment of similar effect. The dose and regimen of HT need to be individualised and in general the appropriate dose is dependent on the menopausal age. Women experiencing urogenital estrogen deficiency symptoms require long-term treatment which is most easily achieved with local estrogen. With the perspective provided by the most recent epidemiological findings not least from the estrogen only arm of the Women's Health Initiative Study (WHI) EMAS supports research activities generating HT with new compositions including lower doses and a wider range of progestins in order to positively affect the balance of clinical benefit and risk. Currently, however, individualized and appropriate prescription of the available HT products together with life-style management will sustain possibilities for beneficial effects on climacteric symptoms, quality of life and degenerative diseases after the menopause.

Estrogen Replacement Therapy↗
PubMed2006

Andropause: a quality-of-life issue in older males.

Testosterone deficiency occurs commonly in men as they grow older. This deficiency often is associated with a decline in sexual activity and a loss of muscle mass. Testosterone replacement can reverse many of these effects. At present, no ideal form of testosterone replacement is available. Like the phosphodiesterase-5 inhibitors, testosterone replacement in older men is a quality of life issue.

Aged↗
PubMed2005

Andropause: is androgen replacement therapy indicated for the aging male?

The number of men in the United States > or =65 years of age is projected to increase from 14,452,000 in 2000 to 31,343,000 in 2030. Approximately 30% of men 60-70 years of age and 70% of men 70-80 years of age have low bioavailable or free testosterone levels. Symptoms and findings of testosterone deficiency are similar to those associated with aging. They include loss of energy, depressed mood, decreased libido, erectile dysfunction, decreased muscle mass and strength, increased fat mass, frailty, osteopenia, and osteoporosis. Several small clinical trials indicate that testosterone replacement therapy can improve many of these findings; however, the studies have not been powered to assess potential risks, such as the need for invasive treatment of benign prostatic hyperplasia, development of a clinical prostate cancer, or cardiovascular events. Thus, the benefit/risk ratio of testosterone replacement therapy in aging men is not known.

Aged↗