[The andropause: slander or calumny? The andropause].
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Aging↗
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Perceptions of and risk factors for andropause.
There has been some controversy about whether males undergo andropause (male equivalent of a menopause). This study seeks to describe how older males perceive and understand this entity. It also explores the possibility of an association between the age of onset of andropause and risk factors such as ethnic origin, smoking, alcohol, hypertension, and cerebrovascular disease. A nonexperimental, cross-sectional study was conducted at the outpatient clinic at a Veterans Affairs Medical Center. Subjects were interviewed by a single investigator and answered a questionnaire consisting of 22 items, including information on patient demographics, patient understanding of andropause, patient understanding of possible interventions with hormonal therapy, medical and drug history, and social habits such as smoking and drinking. Altogether 302 male patients were recruited: 71% of the survey population were above the age of 60 years, and 87% were white, 6% Hispanic, and 5% black. Patient knowledge of andropause was lacking, though the majority (70%) expressed an interest in getting further knowledge. The most frequent age for onset of symptoms related to andropause was 51-60 years, and patients reported symptoms such as impotence, weakness, and memory loss. The next most common age associated with onset was 61-70 years. Multivariate regression analysis revealed that smoking more than 10 cigarettes a day was independently associated with an earlier onset of andropause symptoms bringing down the age of onset to below 50 years (p = .01, OR = 2.5, CI = 1.2-5.3). We found no association with risk factors such as ethnicity or alcohol. Andropause is experienced by many older males but knowledge of the entity is nonuniform. Smokers are at risk for an earlier onset of andropause. This is the first study to look at risk factors for andropause and the results are consistent with studies in females on smoking and menopause.
Adult↗
Perceptions of and risk factors for andropause.
There has been some controversy about whether males undergo an andropause (male equivalent of a menopause). This study seeks to describe how older males perceive and understand this entity and whether there is an association between the age of onset of andropause and risk factors such as ethnic origin, smoking, alcohol, hypertension, and cerebrovascular disease. A nonexperimental, cross-sectional study was conducted at the outpatient clinic at a Veterans Affairs Medical Center. Subjects were interviewed by a single investigator and administered a questionnaire consisting of 22 items, including information on patient demographics, patient understanding of the andropause, patient understanding of possible interventions with hormonal therapy, medical, and drug history, and social habits such as smoking and drinking. Altogether 302 male patients were recruited, 71% of which were above the age of 60 years, and 87% were white, 6% were Hispanic, and 5% were black. The knowledge of patients toward the entity of andropause was lacking, though the majority (70%) expressed an interest in getting further knowledge. The most frequent age of onset of symptoms related to andropause was 51-60 years, and patients reported symptoms such as impotence, weakness, and memory loss. The next most common age reported to he associated with age of onset was 61-70 years. Multivariate regression analysis reveals that smoking more than 10 cigarettes a day was independently associated with an earlier onset of symptoms of andropause, bringing down the age of onset to below 50 years (p = .01, OR = 2.5, CI = 1.2-5.3). We found no association with risk factors such as ethnicity and alcohol. Andropause is experienced by many older males but knowledge of the entity is nonuniform. Older males are at risk for an earlier onset of andropause if they were smokers. This is the first study looking at risk factors for andropause and the results are consistent with studies in females on smoking and menopause.
Adult↗
Memory loss as a reported symptom of andropause.
Andropause seem to be less defined than menopause. This study on older patients describes how they perceive and understand this aging process. A noninterventional, cross-sectional study was performed to determine what men report as symptoms of andropause to ascertain if memory loss was a predominant feature. The hypothesis was that androgens such as testosterone are responsible for visual-spatial and memory development. As such the aging process of andropause, which is associated with declines in testosterone levels, would lead to memory loss. A standardized questionnaire of 22 questions was administered to 302 outpatients of a medical center. Information on patient demographics, understanding of andropause, and risk factors was collected. Of the 302 patients, 71% were above 60 years and whites predominated at 87%. Memory loss was reported in 36% of the patients who felt that they had experienced andropause. It was the third most common symptom after erectile dysfunction (46%) and general weakness (41%). Twenty-two percent of the 302 patients had a history of diabetes. Among those who reported that they had undergone andropause, diabetic patients were more likely to report memory loss (p = .03, OR = 1.9. CI = 1.1-3.4). Sixty-four percent of patients reported the onset of andropause to be between 50 and 70 years (the median age being 50-60 years). This study highlights the importance of testosterone in maintaining cognitive functions. It supports studies of testosterone replacement in men undergoing andropause and who have concomitant dementia. The results parallel recent reports of the neuroprotective effects of estrogens in preventing dementia. Diabetes is associated with memory loss because of the additional insults to cognitive function of the brain secondary to ischemia.
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The influence of sociodemographic factors on awareness, knowledge and attitude toward andropause among health professionals in Ile-Ife, Nigeria.
A descriptive study of the awareness, knowledge and attitude of health professionals toward andropause was conducted in Ile-Ife, Nigeria with the aim of assessing the influence of sociodemographic variables of the respondents on their perspectives of the subject matter. The study employed a structured questionnaire to assess respondents' level of awareness and knowledge, and Likert-type scales to rate respondents' attitudes. A total of 187 (45%) respondents indicated previous awareness of andropause, with younger people (aged below 40 years) displaying better awareness compared with the older ones (p = 0.05), and more doctors than 'other technical health professionals' displaying better awareness when compared with health administrators (p < 0.001). However, only 93 (23%) respondents demonstrated a good knowledge of andropause, with more females compared with males recording good knowledge scores (p = 0.01). While a slightly higher proportion of older respondents (aged 40 years and above) compared with younger ones demonstrated good knowledge of andropause, age and marital status were not significantly related to knowledge of the subject matter. While only 23 (5.4%) respondents displayed a positive attitude toward andropause, and respondents' knowledge was found to positively influence their attitude toward it, none of the sociodemographic variables of age, sex or marital status was significantly related to respondents' attitudes. The study concluded that there is still a low level of awareness and knowledge of andropause among health workers in Nigeria, unlike what obtains in more developed countries of the world, and called for active education of both health professionals and the general public on the subject matter of andropause and other related male reproductive health concerns in the country.
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Increased carotid atherosclerosis in andropausal middle-aged men.
OBJECTIVES: This study examined the association between carotid artery intima-media thickness (IMT), serum sex hormone levels, and andropausal symptoms in middle-aged men. BACKGROUND: Male sex hormones may play a dual role in the pathogenesis of atherosclerosis in men by carrying both proatherogenic and atheroprotective effects. METHODS: We studied 239 40- to 70-year-old men (mean +/- SD: 57 +/- 8 years) who participated in the Turku Aging Male Study and underwent serum lipid and sex hormone measurements. Ninety-nine men (age 58 +/- 7 years) were considered andropausal (i.e., serum testosterone <9.8 nmol/l or luteinizing hormone [LH] >6.0 U/l and testosterone in the normal range), and in both situations, they had subjective symptoms of andropause (a high symptom score in questionnaire). Three were excluded because of diabetes. The rest of the men (age 57 +/- 8 years) served as controls. Carotid IMT was determined using high-resolution B-mode ultrasound, and serum testosterone, estradiol (E2), LH, and sex hormone-binding globulin were measured using standard immunoassays. RESULTS: Andropausal men had a higher maximal IMT compared with controls in the common carotid (1.08 +/- 0.34 vs. 1.00 +/- 0.23, p < 0.05) and in the carotid bulb (1.44 +/- 0.48 vs. 1.27 +/- 0.35, p = 0.003). Common carotid IMT correlated inversely with serum testosterone (p = 0.003) and directly with LH (p = 0.006) in multivariate models adjusted for age, total cholesterol, body mass index, blood pressure, and smoking. CONCLUSIONS: Middle-aged men with symptoms of andropause, together with absolute or compensated (as reflected by high normal to elevated LH) testosterone deficiency, show increased carotid IMT. These data suggest that normal testosterone levels may offer protection against the development of atherosclerosis in middle-aged men.
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Erectile dysfunction and andropause symptoms in infertile men.
PURPOSE: We evaluated the prevalence of andropause symptoms and erectile dysfunction in our infertile population. MATERIALS AND METHODS: A total of 302 consecutive men presenting for infertility evaluation and 60 consecutive men with proven fertility seeking vasectomy (controls) were administered the Androgen Deficiency in the Aging Male and Sexual Health Inventory for Men (SHIM) questionnaires. Information regarding other clinical parameters, including seminal parameters, was collected by review of patient charts. RESULTS: Of the 302 infertile men screened, 38% reported significant andropause symptoms and 28% had abnormal SHIM scores. Of the subgroup of infertile men with nonobstructive azoospermia, 25% reported andropause symptoms and 27% had an abnormal SHIM score. In the fertile group 21% reported andropause symptoms and only 11% had an abnormal SHIM score. The prevalence of erectile dysfunction in infertile men was significantly higher than in the fertile controls (p = 0.007). CONCLUSIONS: Andropause symptoms and erectile dysfunction are common among infertile men, affecting approximately 38% of this population. This finding suggests that the population of infertile men should be carefully screened to identify and treat those with erectile dysfunction.
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Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria.
Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.
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[Histological structure of the testes in andropause].
A structure of the convoluted tubuli, spermatogenesis and number of Leydig's cells in the andropause have been analysed in dependence on the degree of symptoms intensity. A control group included otherwise healthy men with ++post-inflammatory azoospermia. A percentage of the convoluted tubuli with normal tissue (p < .002) and spermatogenesis (p < .001) has been significantly decreased in andropause. The number of Leydig's cells has not differed in andropause and in a control group (p < .05). No difference of significance have been noted in the structure of convoluted tubuli, spermatogenesis, and Leydig's cells number depending on the intensity of symptoms. FSH and LH levels have been significantly increased in andropause (p < .001). No relationship between FSH and LH levels and percentage of the abnormal convoluted tubuli has been observed. However there have been a relationship between FSH and LH levels and the number of abnormal convoluted tubuli with spermatogenesis inhibition and intensified clinical symptoms. There has also been a relationship between FSH and LH levels and Leydig's cells number in patients with marked symptoms of andropause.
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Andropause: knowledge and perceptions among the general public and health care professionals.
BACKGROUND: Andropause, the natural age-related decline in testosterone in men, has been debated in the literature. The nonsexual benefits of testosterone replacement therapy (TRT) in male hypogonadism are well documented, but whether health care professionals (HCPs) and members of the general public are aware of these benefits is not known. This study assesses the knowledge and perceptions of andropause and TRT among HCPs and members of the general public. METHODS: Brief surveys were administered to HCPs and members of the general public who called a medical information telephone line. Trained clinical interviewers surveyed participants for experiences with andropause and TRT and knowledge about nonsexual effects of low testosterone in men. RESULTS: Of 443 general public callers, 377 (85%) agreed to participate in the survey. Of these participants, 77% had heard of andropause or male menopause, and 63% had taken TRT. Of 88 HCP callers, 57 (65%) participated. Of these participants, 65% were pharmacists, 80% had encountered patients with symptoms of low testosterone, and 50% reported that patients rarely or never initiated conversations about low testosterone. Among HCPs and the general public, respectively, 98% and 91% knew that low testosterone is treatable with medication, and 60% and 57% knew that it results in osteoporosis. Only 25% of HCPs and 14% of the general public knew that low testosterone does not cause loss of urinary control. CONCLUSIONS: HCPs and members of the general public are knowledgeable about some aspects of low testosterone and have misconceptions about others. Educational initiatives are needed.
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Andropause: symptom management for prostate cancer patients treated with hormonal ablation.
Andropause, or the age-related decline in serum testosterone, has become a popular topic in the medical literature over the past several years. Andropause includes a constellation of symptoms related to lack of androgens, including diminished libido, decreased generalized feeling of well-being, osteoporosis, and a host of other symptoms. The andropause syndrome is very prominent in men undergoing hormonal ablation therapy for prostate cancer. Most significant in this population are the side effects of hot flashes, anemia, gynecomastia, depression, cognitive decline, sarcopenia, a decreased overall quality of life, sexual dysfunction, and osteoporosis with subsequent bone fractures. The concept of andropause in prostate cancer patients is poorly represented in the literature. In this article, we review the current literature on the symptoms, signs, and possible therapies available to men who cannot take replacement testosterone.
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[Testosterone and depression in men aged over 50 years. Andropause and psychopathology: minimal systemic work-up].
A reduced feeling of well being with unusual anxiety and irritability, nervousness, mood swings and a depressive state are often mentioned as the psychological symptoms of the age-related hypogonadism. However, psychological aspect of andropause has not yet been specifically studied and most data on psychological symptoms come from researchers' clinical impressions rather than from systematic studies. Therefore, it seems premature to assign them to the age-associated decline in testosterone levels. The implication of testosterone in psychological state has yielded mixed results. Among elderly men, lower testosterone levels were associated with depressive or dysthymic symptoms. Moreover, lower testosterone levels were reported in men with depression, independently of age. In contrast, some studies did not observe any significant difference in testosterone levels between depressed men and controls. Furthermore, several studies have suggested that testosterone replacement improved mood in hypogonadal men, but others did not, as in studies on eugonadal men. Several researchers have also suggested the potential use of testosterone as an antidepressant or adjuvant to current treatments in depressed hypogonadal men. The relationship between andropause and psychological symptoms such as depression is far from clear. Andropause may be associated with "minor depressive symptoms" that are not considered as pathological. Psychological manifestations do not appear specific to andropause and probably have a multifactorial origin.
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Novel treatment options for overlapping yet distinct erectile dysfunction and andropause syndromes.
The Food & Drug Administration has recently approved, or is in the process of approving newer drugs such as the phosphodiesterase inhibitors and apomorphine to treat men's health issues including erectile dysfunction. Increasing age results in a gradual hypogonadal state in men, for which different novel delivery systems of androgens are currently offered for the symptomatic patient. As such, many men are presenting to healthcare practitioners for the first time. The age of presentation for erectile dysfunction and andropause often overlaps, typically in the fifties and beyond, therefore, it makes sense to screen for erectile dysfunction in andropause patients and vice versa. Erectile dysfunction is usually a harbinger for other illnesses, such as coronary heart disease and depression. The hypogonadal state, likewise, could be a harbinger for other ill health states in men, including obesity, depression, osteoporosis and possibly memory loss. While the newer treatments for erectile dysfunction and andropause are distinctly different and targeted at symptom relief, the presentation of the patient with erectile dysfunction or andropause offers an excellent opportunity for screening for other health states and health education strategies.
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[Gonadal intraparenchymatous functional reserve in andropause].
Blood plasma testosterone (T), estradiol (E2) levels and gonadal reserve in 43 patients aged between 50 and 66 years with andropause symptoms have been determined. The patients were divided into 3 subgroups depending on the severity of the symptoms. No significant difference was noted in T level of these patients compared to the range in younger males as well as a control group of corresponding age but with no andropausal symptoms. E2 level was significantly elevated in the observed group compared to the two control groups. No difference was noted in T and E2 levels between the 3 subgroups of the andropausal patients. Gonadal reserve in the observed group was significantly lower compared to the control groups of the younger males. No significant difference was noted in the gonadal reserve between 3 subgroups of the andropausal patients.
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No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause'.
BACKGROUND: The measurement of bioavailable testosterone (BT) or free testosterone (FT) levels is currently considered the gold standard for the diagnosis of androgen deficiency in elderly men. While the impact of age on circulating testosterone levels (total, bioavailable and free) has been strongly documented, the existence of seasonal variations in testosterone levels remains debated. OBJECTIVE: We investigated whether seasonal variations in serum calculated free testosterone (cFT) levels may translate into variations in the prevalence of low testosterone levels. Diagnosis was on the basis of biochemical determinations and was cross-checked with the prevalence of clinical signs and symptoms of 'andropause', as assessed by the Androgen Deficiency in Aging Males (ADAM) questionnaire. METHODS: The study recruited 5028 men aged 50 years and over from September 2000 to January 2003. Their serum FT levels were assessed and they completed the French ADAM test. Men were considered eugonadal when cFT was > or =70 ng/l. The ADAM test was scored as described originally. The prevalence of 'andropause', diagnosed by the two methods, was compared throughout the year, on a month by month basis. RESULTS: The percentage of subjects with cFT levels below 70 ng/l increased significantly with age (P<0.001). Serum cFT levels (mean [SD]) varied significantly with the month of sampling (P<0.0001), the highest (88.1 [30.2] ng/l) and lowest (76.9 [28.0] ng/l) mean values occurring in April and in October, respectively. Conversely, the prevalence of testosterone deficiency (cFT<70 ng/l) reached a peak in October (45.7%) and a nadir in April (29.7%). Although the prevalence of 'andropause', based on the ADAM questionnaire, increased significantly with age (P<0.0001), no influence of the month of the year was noticed. CONCLUSIONS: Our results confirm a progressive age-related decline in FT levels. The monthly variations in serum FT values, observed throughout the year, do not show a major seasonal rhythm in elderly community-dwelling males, since the magnitude of the variations (<15%) remains marginal. This slight variation may, however, have an impact on the number of elderly men diagnosed with Partial Androgen Deficiency in Aging Males (PADAM).
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Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies.
The existence of the so-called 'andropause' is an irrefutable fact, although the terms 'SLOH' (symptomatic late-onset hypogonadism) or 'symptomatic ADAM' (androgen deficiency of the aging male) are more accurate. The term 'andropause' is, in most cases, inappropriate, except when the gonads cease functioning. Testosterone production decreases as a function of age, but this decrease is not universal. Several clinical manifestations are associated with hypogonadism, but these are not solely attributable to hypogonadism. Other hormones (i.e. dehydroepiandrosterone, growth hormone, thyroxine and melatonin) also decrease with age. Such multi-hormone alterations are closely inter-related and may influence 'andropause-related' symptoms. Many patients with SLOH, although by no means all, respond well to testosterone therapy. Although testosterone therapy can induce adverse effects, these can be largely minimized by proper monitoring by a knowledgeable clinician. Extrapolation of the effects of estrogens + progesterone in menopausal women to the use of testosterone in hypogonadal men is mythical, and more research on the effect of exogenous sex steroids in aging men and women is needed. However, to restrict the prescription of such hormones until all issues have been fully addressed is impossible. Indeed, the discourse on SLOH would benefit considerably from more science and less speculation.
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Can we get away from serum total testosterone in the diagnosis of andropause?
Because of its multifactorial origin, andropause is usually considered as a clinical entity whose diagnosis is difficult. Practitioners sometimes distrust the symptoms and the diagnostic tools. The clinical manifestations are however the reflection of a lack of anabolism commonly associated with a decreased production of testosterone which is translated in decreased serum values of total testosterone, bioavailable testosterone and calculated values of testosterone. Because of the similarity between the age of the control group and of andropausal men in this study, the Sex Hormone Binding Globulin dogma postulating a modest increase of the glycoprotein with age is evacuated from the argument and therefore it is proposed to rely on total testosterone as a first line assay to support the diagnosis of andropause; however the presence of confounding factors to the diagnosis sometimes require an easy access to calculated values of free or bioavailable testosterone.
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Andropause and psychopathology: minor symptoms rather than pathological ones.
This study examined the psychological symptomatology of men diagnosed with andropause and the association between calculated free testosterone (T) and depressed mood, anxiety and quality of life. Subjects were 153 men, aged 50-70 years, who participated in a screening of andropause. Total testosterone, FSH, LH and SHBG levels were measured. Depressed mood was assessed with the Carroll Rating Scale, anxiety with the "anxiety-insomnia" dimension of the General Health Questionnaire, and quality of life with the World Health Organisation Quality of Life questionnaire. The results showed that levels of free T decreased with age, whereas FSH and LH increased. Carroll Rating Scale scores were higher among hypogonadal subjects, but the mean score was low and not pathological. A negative correlation was observed between severity of depression as assessed by the Carroll Rating Scale and free T levels. However, subjects with a significant score on this scale did not exhibit different free T levels compared to subjects with a non-significant depressive score. Anxiety and quality of life did not differ between hypogonadal and eugonadal subjects. The present study therefore suggests that andropause is not characterised by specific psychological symptoms, but may be associated with "depressive symptoms" that are not considered as pathological.
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