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[Testosterone treatment of elderly men. The so called andropause doesn't exist].
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Endocrinology of menopause and "andropause". Proceedings of the 46th International Meeting of Clinical Endocrinology Henri-Pierre Klotz. Paris, France, 2003.
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Andropause or the male climate.
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[The "andropause"--fact or fiction?].
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[Biological manifestations of the andropause].
Aging in men is accompanied by signs of decreased virility and fertility: testicular volume, muscle mass, pilosity, sexual activity, daily production of spermatozoa, plasma testosterone levels, the number of Leydig cells and blood supply of the testicles decrease significantly with age. The pulsatility of LH levels in young and elderly men has been studied by taking plasma samples with an interval of 10 minutes for 12 hours. Age alterations at the hypothalamic-pituitary levels of testosterone production and an increase in gonadostat sensitivity to hormonal influences realized via the feedback mechanism are found. Whenever androgen therapy of eugonadal elderly men is considered, a sufficient dosage should be administered, as otherwise, due to the feedback effects, administered androgens, suppressing endogenous secretion might not increase plasma-testosterone levels. Changes in neurotransmitters and neuromodulators play a determinant role in the sexual behaviour of elderly men.
Considerations regarding the usage of Gerovital-H 3 during andropause for disturbances of sexual dynamics.
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[Andropause, male climacteric and crisis of the fifties: should androgens be administered?].
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'Andropause'--are reduced androgen levels in aging men physiologically important?
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[Menopause and andropause as a public health problem].
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Partial androgen deficiency in aging type 2 diabetic men and its relationship to glycemic control.
Aging in the male is associated with both a higher incidence of type 2 diabetes and hypogonadism. However, little information is available about the complex of symptoms and hormonal changes related to partial androgen deficiency in aging (called andropause) in type 2 diabetic men. Here, for the first time, we used a combination of clinical and hormonal criteria to define andropause and to analyze the relationships between the androgen environment and glucose metabolism in 55 type 2 diabetic men (63.6 +/- 7.9 years, mean +/- SD). Low plasma levels of total testosterone (< or =3.4 ng/mL) and free testosterone (< or =11 pg/mL) were found in 20% and 54.5%, respectively, of the diabetic men. The fraction of diabetic men with subnormal levels of total testosterone increased with aging: 14.2% (50 to 59 years), 17.4% (60 to 69 years) and 36% (> 70 years). The corresponding figures for subnormal values of free testosterone were 38%, 69.6%, and 54.5%, respectively. In the whole group of type 2 diabetic men, no significant linear correlations between total or free testosterone with fasting plasma glucose, insulin, C-peptide, or fructosamine values could be established. Total testosterone was positively correlated with glycosylated haemoglobin (HbA(1c)) levels (r =.322, P =.01). Although fasting plasma glucose was marginally higher in aging type 2 diabetic patients with andropause than in those without andropause (162 +/- 6.9 v 139 +/- 8.9, mean +/- SEM, P =.05), there were no differences between both subgroups for plasma fasting insulin, C-peptide, fructosamine, or HbA(1c) levels. Replacement therapy (150 mg intramuscular [IM] of enanthate of testosterone every 14 days for 6 months) was applied in 10 type 2 diabetic men with clinical features of andropause associated with subnormal concentrations of serum testosterone. The treatment induced significant increases in total plasma testosterone (baseline: 3.9 +/- 0.3; at 6 months: 7.1 +/- 0.9 ng/mL, mean +/- SEM, P =.003) and free testosterone (baseline: 9.3 +/- 0.6; at 6 months 17.6 +/- 2.4 pg/mL, P =.003), but had a neutral effect on overall glycemic control. These data show a high prevalence of andropause in aging type 2 diabetic men and suggest that the endogenous androgen environment, as well as correction of the partial androgen deficiency, do not have a meaningful effect on glycemic control.
The Philippine Male Aging Survey.
The aging male is fast becoming a global concern. The problem is predicted to become a major health issue that should be addressed immediately in order to prevent disability, morbidity, and, more importantly, mortality. As part of its commitment to increase awareness and create interest in the care of Filipino aging males, The Philippine Society for the Study of the Aging Male Foundation, Inc. (PhiSSAM), a multi-specialty society established in 2000, embarked on a survey among Filipino physicians to determine their knowledge, attitudes, and practices regarding male aging. Results showed that the majority of doctors (about 87%) thought that men may experience andropause. Most would diagnose patients based on symptoms alone, while only 20-30% used testosterone levels to make a diagnosis of andropause. Decreased libido and less strong erections were the symptoms very closely associated with low testosterone. Of those doctors responding, 89% agreed that andropause can affect the quality of a man's life as much as menopause can affect a female; only 38% had already prescribed/instituted treatment for andropause. Of the 62% non-prescribers, 58% said they were either very likely or fairly likely to institute treatment in the future if there were more clinical trials, more medical information, and more information on drugs. Major concerns on testosterone replacement therapy included prostate cancer, benign prostatic hypertrophy, and heart disease. The findings in this pilot survey indicate a need among the doctors in the Philippines for education about andropause and the available treatments.
Point: urologists should take an active role in the diagnosis and treatment of hypogonadism in the aging male.
Andropause is a problem that can be identified in some men as distinct from the changes associated with aging or chronic disease. These men have mild hypogonadism and a clinical picture that is well within the scope of urologists to identify and manage. Andropause is neither life threatening nor trivial and there are clinical guidelines published that will help to refine the understanding and definition of this condition. The character of andropause is distinct from profound hypogonadism in its relation to age, the scope and degree of contributing symptoms and the marginal reduction in testosterone. Testosterone is the established treatment for some men with andropause and the links between testosterone and cancer of the prostate create an overlap in management that places a premium on urological expertise. Obviously men with cancer of the prostate must not be given testosterone and some men may have clinical andropause and undetected cancer of the prostate. However, current understanding points to the fact that there is no additional risk from re-establishing a normal androgen environment (androgen replacement) in terms of initiating a new cancer of the prostate while testosterone will encourage growth of an established cancer. Therefore, the natural good practice of urology, and only urology, intrinsically encompasses the major issues inherent in the medical collision of cancer of the prostate and testosterone replacement. The good practice of urology includes the use of androgen replacement therapy in men who need it and have been assessed for the presence of cancer of the prostate.