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While not as severe as the female menopause, the male version is lengthier, usually lasting 15 to 20 years. About 40% of men in their 40s, 50s and 60s experience some degree of lethargy, depression, increased irritability, mood swings, and difficulty in attaining and sustaining erections that characterize andropause.
The concept of a male andropause has been more controversial than that of the female menopause, with many arguing that it doesn't even exist. Part of the reason for the controversy is that, in contrast to women, men do not have a clear-cut external sign, namely the cessation of menstruation.
Causes & Development
A man often begins to experience changes in his body somewhere between the ages of 40 and 55. These bodily changes may be accompanied by changes in attitudes and moods. The aging process alone can not be responsible for this problem as well over 40% of males remain sexually active at 70 years of age and beyond.
Acute andropause in men is relatively uncommon, compared to acute menopause in women, because testicular function declines gradually in most men. There are a number of other causes, however, for acute testicular failure in adult men and these include: viral infections such as mumps, surgical removal of or surgical injury to the testes and male reproductive tract, diseases when the immune system attacks and destroys the testes such as variations of systemic lupus erythematosis, subtle genetic abnormalities which permit normal adult development but lead to premature testicular failure, generalized vascular diseases such as diabetes, chemotherapy, and pituitary tumors (rare).
The second form of this syndrome, while more common, is more insidious since it occurs gradually. It is often confused with male midlife psychological adjustment disorders because it exactly mimics depression in midlife men. Some known contributors to this condition are excessive alcohol consumption, smoking, hypertension, prescription and non-prescription medications, poor diet, lack of exercise, poor circulation, and psychological problems.
Male hormones decline gradually. Testosterone (from the testes), human growth hormone (from the pituitary), and DHEA and androstenedione (from the adrenal gland) levels all begin to drop. For many men this does not occur until their 60s or 70s but there are others where it occurs much earlier. In addition, there are proteins in the blood which bind testosterone into a biologically inactive form - sex hormone binding proteins or globulins. Their levels can rise in response to many conditions including medical disorders and exposure to other hormones such as phytoestrogens (estrogens derived from plant sources such as soy) and environmental estrogen-like compounds (pesticides, hormones used in agribusiness to produce fatter animals, etc.) As an example, there is some data suggesting that men on low fat or vegetarian diets have lower testosterone levels. The overall effect of rising sex hormone binding proteins is that there is less bio-available testosterone.
Signs & Symptoms
Typical symptoms include:- Fatigue, loss of a sense of well being -- 82%
- Joint aches and stiffness of hands -- 60%
- Hot flashes, sleep disturbances -- 50%
- Depression -- 70%
- Irritability and anger -- 60%
- Reduced libido -- 80%
- Reduced potency -- 80%
- Premature aging
- Weight gain
- Changes in hair growth and skin quality
- Intimacy problems, such as trying to establish closer relationships with family members
- Hot flashes, which occur only in approximately 1 in 10 men experiencing andropause
- Osteoporosis (weakening or loss of bone mass)
- Hair loss in armpits and genital area
- Shrinkage in size of sexual organs.
This list sounds a little similar to women in menopause because it is the same condition. The relationship between the ovaries, estrogen, the brain, and the pituitary are the same as the relationship between the testes, testosterone, the brain, and the pituitary.
Diagnosis & Tests
The diagnosis is simple - measuring either free testosterone blood levels or computing the Free Androgen Index (FAI) which is [total testosterone x 100 / sex hormone binding globulin]. There is some controversy as to what level of total blood testosterone in men is normal with low end values ranging from 250-400ng/dl. Free testosterone in men should be well within the range of 300-1100ng/dl with the FAI between 70-100%. At a FAI of less than 50%, symptoms of andropause appear.
Treatment & Prevention
Risks of replacement therapy. Though often suggested, there is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer. Men using synthetic testosterone supplementation should have their serum lipids carefully evaluated and rechecked periodically. Using a natural testosterone is safer than using a synthetic form, but may require the transdermal route of administration.
As a general principle, whenever any hormone is administered, the gland which normally produces it ceases to function and recovery when therapy stops can be variable. Patients with borderline low testosterone levels may be committing themselves to lifelong therapy if they start with testosterone replacement.
Benefits of replacement therapy
There is no doubt that the administration of testosterone to men with true testosterone deficiency will improve their health and sense of well being. The symptoms listed above should disappear. Unfortunately impotence, or the inability to sustain and erection, does not respond well to testosterone therapy except perhaps in men with severe hormone deficiencies. This comprises approximately 8-16% of men presenting themselves to physicians with erectile disorders. There is no evidence that administering testosterone to men with borderline low testosterone levels will improve sexual functioning, although libido may be enhanced.
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Signs, symptoms & indicators of Andropause/Male Menopause:
Conditions that suggest Andropause/Male Menopause:
Risk factors for Andropause/Male Menopause:
Recommendations and treatments for Andropause/Male Menopause: | | | | | Action |  Book Reading | For more insight, The Testosterone Syndrome, by Eugene Shippen, M.D. and William Fryer, provides a persuasive argument in favor of hormone modulation in the male andropause. |
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Amino Acid / Protein |
 Acetyl-L-Carnitine| | The April 2004 issue of the journal Urology published the findings of Italian researchers that the amino acid carnitine was more active than testosterone in improving symptoms of aging in men, such as sexual dysfunction and depression, associated with the decline of androgenic hormones.
120 men between the ages of 60 and 74 with symptoms of low testosterone were randomized to receive 160mg orally administered testosterone undecanoate, 2gm propionyl-L-carnitine plus 2gm acetyl-L-carnitine per day, or a placebo for a six month period.
Erectile function, sexual desire, sexual satisfaction and nocturnal penile tumescence increased over the course of the study in the group receiving testosterone as well as in the group receiving carnitine. However, the group receiving carnitine also experienced an increase in orgasm and general sexual well-being. Erectile function and nocturnal penile tumescence were significantly more improved in this group than in those receiving testosterone. While both treatments lowered depression scores, carnitine's effect was greater.
Predictably, treatment with testosterone increased serum total and free testosterone and decreased luteinizing hormone levels, but carnitine's effect on these hormones was not significant. Treatment with carnitine was not associated with an increase in prostate volume as was testosterone treatment.
Fatigue was likewise improved in both groups. As one negative effect, the men taking testosterone developed enlargement of their prostates, which did not occur in the carnitine-treated group. Although both testosterone and carnitine improved symptoms of male aging, there was overall superior benefit to carnitine with no real side-effects. |
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Botanical |
Tribulus| | Administration of tribestan, an extract of Tribulus, leads to increased muscle mass during exercise by activating an enzyme associated with energy metabolism. It has also been reported to increase the body's natural testosterone and lutenizing hormone (LH) levels. With the increase of testosterone it has helped to alleviate some symptoms associated with male menopause. |
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Extract |
DIM (di-indolmethane)/I3C (Indole-3-Carbinol)| | There is a new appreciation of the effects of changing estrogen metabolism that come with male aging, now identified as andropause. German researchers have clearly documented a dramatic, aging-related accumulation of estrogen in human prostate glands. This work correlated age, estrogen accumulation, and the presence of benign prostatic hypertrophy (BPH). This underscores the role of estrogen as a growth promoting hormone in men as well as women.
Tissue accumulation of estrogen is a unique hallmark of andropause, distinct from estrogen deficiency which characterizes menopause. Recent work shows that estradiol, the active form of estrogen, provokes increases in prostate specific antigen (PSA) production in human prostate tissue. This increase in PSA is as great as that seen with testosterone. Increased PSA production was specifically inhibited by 2-methoxyestradiol, the beneficial estrogen metabolite whose production is promoted by DIM.
Accumulation of estrogen during andropause is amplified by obesity since fat tissue is the site of conversion of both testosterone and DHEA into estrogen. In case control studies, higher levels of circulating estrogen predict the degree of prostate enlargement. More importantly, increased estrogen levels have been repeatedly noted as a risk factor for early atherosclerosis and heart attack. The risks of elevated estrogen in men further correlate to decreased ability to dissolve blood clots. The specific deficiency in men of an active, beneficial metabolism of estrogen leading to 2-methoxy estrogens would explain many, if not all, of these observations.
In studies culturing human vascular endothelial cells, it has been shown that 2-methoxy estradiol is a primary regulator of cell growth and apoptosis. Active and regulated apoptosis may contribute to the prevention of atherosclerotic plaque formation. At the basic level of lipoprotein status, 2-hydroxy and 2-methoxy estrogens are powerful antioxidants. In recent experiments, these metabolites, whose production is promoted by DIM, have been shown to prevent the oxidation of human lipoproteins. Lipoprotein oxidation is now accepted as an early, initiating event in atherosclerosis. While it remains to be demonstrated through intervention studies that DIM supplementation can slow the progression of prostate disease and atherosclerosis, it is clear that DIM supplementation in men can beneficially shift estrogen metabolism. |
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Hormone |
Testosterone| | Testosterone levels decline gradually with age in men. The clinical significance of this decrease is debatable, and there is no general agreement regarding if and when to treat aging men with testosterone replacement therapy. The position of the American Society of Andrology is that testosterone therapy "is indicated when both clinical symptoms and signs suggestive of androgen deficiency and decreased testosterone levels are present". Unfortunately, the signs and symptoms are non-specific, and are generally associated with aging such as loss of muscle mass and bone density, decreased physical endurance, decreased memory ability and loss of libido. |
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Lab Tests/Rule-Outs |
Test for Hormones| | Hormone testing and replacement will help to reduce symptoms and prevent the consequences associated with premature hormone reductions seen in male menopause. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Weakly counter-indicative | | | Likely to help | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Androgen
Any steroid hormone that increases male characteristics.
Antigen (Antigenic, Antigens)
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Antioxidants are substances that protect cells from oxidative damage caused by molecules called free radicals. These chemicals can damage important parts of cells, such as proteins, membranes, and DNA. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Apoptosis
Programmed cell death as signaled by the nuclei in normally functioning human and animal cells when age or state of cell health and condition dictates. Cancerous cells, however, are unable to experience the normal cell transduction or apoptosis-driven natural cell death process.
Atherosclerosis
Common form of arteriosclerosis associated with the formation of atheromas which are deposits of yellow plaques containing cholesterol, lipids, and lipophages within the intima and inner media of arteries. This results in a narrowing of the arteries, which reduces the blood and oxygen flow to the heart and brain as well as to other parts of the body and can lead to a heart attack, stroke, or loss of function or gangrene of other tissues.
Benign Prostatic Hypertrophy (Benign Prostatic Hyperplasia, BPH)
The benign buildup in the prostate of "warts" or epithelial neoplasias that can block or interrupt urination, and which are usually concurrent with moderate prostate enlargement. They cause a dull ache on urination, ejaculation, and/or defecation. The diagnosis is medical, since the same subjective conditions can result fromcancer of the prostate. BPH is common in men over fifty and can be the result either of diminished production of complete testosterone or poor pelvic circulation. Alcohol, coffee, speed, and antihistamines can all aggravate the problem.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Carnitine
A compound found in skeletal and cardiac muscle and certain other tissues that functions as a carrier of fatty acids across the membranes of the mitochondria. Carnitine has been used therapeutically in treating angina and certain deficiency diseases.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Deciliter (dL)
0.1 or one tenth of a liter.
DHEA (DHEA-S)
Dehydroepiandrosterone (DHEA) is a steroid produced by the adrenal glands and is the most abundant one found in humans. DHEA may be transformed into testosterone, estrogen or other steroids. It is found in the body as DHEA or in the sulfated form known as DHEA-S. One form is converted into the other as needed.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Endothelium (Endothelia, Endothelial, Endothelioid)
A thin layer of flat epithelial cells that lines serous cavities, lymph vessels, and blood vessels.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Insidious
A symptom or condition of gradual onset or development.
Lipid (Lipids)
Fat-soluble substances derived from animal or vegetable cells by nonpolar solvents (e.g. ether); the term can include the following types of materials: fatty acids, glycerides, phospholipids, alcohols and waxes.
Lipoproteins (Lipoprotein)
Molecules composed of lipids and proteins that carry fats and cholesterol through the bloodstream.
Luteinizing Hormone
Anterior pituitary hormone stimulating estrogen production by the ovary; promoting formation of progesterone by the corpus luteum in women and stimulating testosterone release in men.
Menopause (Menopausal)
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Metabolite (Metabolites)
Any product (foodstuff, intermediate, waste product) of metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Mumps
An acute infectious disease, caused by a paramyxovirus, and most common in children. Although it usually infects the parotid glands, and is often only a mild condition, it can spread to the testes or ovaries and cause serious problems, particularly when contracted by unresistant adults. A mild child's infection that is not properly monitored holds the potential for pancreatic or meningeal complications.
Nanogram (ng)
0.000000001 or a billionth of a gram.
Osteoporosis
A disease in which bone tissue becomes porous and brittle. The disease primarily affects postmenopausal women.
Ovary (Ovaries)
Ovaries are about the size of an almond and lie on either side of the lower abdomen beside the uterus. They usually produce one egg each month and whether the egg is fertilized or not, the reproductive process follows a monthly cycle, with constant changes in various hormone levels, preparing another opportunity for conception. The ovary is responsible for most of the estrogen production in women. At menopause (sometime after middle-age), egg production ceases and hormone levels drop significantly.
Phytoestrogen (Phytoestrogens)
A plant substance with activity similar to human estrogen, but with important differences. Like real estrogen, plant estrogens bind to estrogen receptors in cells, thereby preventing real estrogen from binding to these cells. Unlike real estrogen, however, plant estrogens do not stimulate cell growth, therefore, plant estrogens are believed to inhibit the growth of tumors that would normally be stimulated to grow by real estrogen.
Pituitary (Pituitary Gland)
The pituitary gland is a small (half-inch), bean-shaped organ that hangs down from the lower center of the brain on a stalk attached to another gland, the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands. It regulates many body activities, and is partitioned into front and back lobes. The front lobe is stimulated by the hypothalamus, and produces any one of six different hormones that in turn stimulate the thyroid, adrenal and reproductive glands, and also breast milk production.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Prostate
The prostate gland in men that surrounds the neck of the bladder and the urethra and produces a secretion that liquefies coagulated semen.
Protein (Proteins)
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
SHBG (Sex Hormone Binding Globulin, Sex Hormone-Binding Globulin)
A glycoprotein, synthesized in the liver, which binds testosterone and 5 alpha-dihydrotestosterone strongly, and estradiol somewhat less strongly. Circulating testosterone is mainly bound to protein - primarily SHBG, but also to albumin and cortisol-binding globulin. Since variations in the carrier protein levels may affect the concentration of testosterone in circulation, SHBG levels are commonly measured as a supplement to total testosterone determinations. The "free androgen index" (FAI), calculated as the ratio of total testosterone to SHBG, has proved to be a useful indicator of abnormal androgen status in conditions such as hirsutism.
Syndrome
A medical condition characterized by a collection of related symptoms (what the patient feels) and signs (what a doctor can observe or measure).
Testicles (Testicle, Testicular)
Egg-shaped sex glands in the scrotum that secrete male hormones such as testosterone, and produce sperm.
Testosterone
The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Vegetarian (Lacto-Ovo-Vegetarian, Vegetarianism, Vegetarians)
A person who consumes no meat, fish or fowl (chicken, turkey, etc.), but who may consume animal products such as dairy products (milk, cheese, butter, etc.), eggs or honey.
Last updated: Oct 08, 2008
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