Andropause, the Male Menopause

As we progress with age, our sexual hormones reduce gradually. In females, this occurrence is known as menopause. The male counterpart to this is known as Andropause. Male levels of sexual hormones start to gradually decline when they enter their 4th or 5th decades of life. There are some men who start to undergo this change much earlier, such as in their 3rd decade of life.

What is the Cause of Andropause?

Andropause occurs when a man’s testosterone level is low. Testosterone is a hormone produced by the testes. It Is the male hormone responsible for a male’s physical characteristics such as sexual drive (libido), facial and body hair, deep voice, muscle mass, and competitive personality.

The onset of Andropause can occur earlier. This can be attributed to multiple factors, including genetic cases, lifestyle and certain medical conditions. Common chronic medical conditions such as metabolic conditions (i.e. obesity, hypertension, diabetes, raised cholesterol) are associated with earlier Andropause. Andropause can also occur in patients with testicular cancer, or patients who are taking medication to lower their testosterone as part of treatment of prostate cancer.

What are the Symptoms of Andropause?

  • Low libido (low sex drive)
  • Low energy level, feeling perpetual lethargy
  • Unexplained low mood and depression
  • Unable to concentrate
  • Mood swings, behavioral changes
  • Erectile dysfunction and problems during ejaculation
  • Reduction in muscle mass
  • Reduction in bone density
  • Developing breasts (gynecomastia)
  • Loss of body and facial hair

What do I expect when I see my doctor?

Your doctor will take relevant medical histories, understanding your concerns and expectations, and perform general physical examination. Your doctor will offer you blood tests such as blood sugar counts, cholesterol levels, kidney, liver and cell count blood tests. This is to screen for chronic medical conditions. Hormonal blood tests will be offered as well.  Diagnosis will be based on physical examination and hormonal blood tests to determine if the patient has low testosterone levels.

What are the treatment options of Andropause?

While testosterone replacement is the backbone treatment for Andropause, this condition should be managed in a holistic manner, targeting different psychosocial and medical aspect of the associated condition.

Few important aspects to focus on:

  • Managing any long term concurrent chronic metabolic conditions
  • Encouraging a healthy lifestyle, moderating alcohol consumption, quitting smoking, exercising regularly to maintain a good body weight
  • Addressing other sexual health problems such as erectile dysfunction, ejaculation problems, testosterone deficiency symptoms
  • Considering mood management through seeing a psychologist

As mentioned, treatment of Andropause largely revolves on testosterone replacement in the form of

  • Testosterone gel
  • They are easy to use, and should be applied every morning over the shoulders or upper arms.
  • You are advised not to shower or swim for at least 5 hours after application to ensure absorption of gel into the body.
  • Importantly, avoid coming near a naked flame or smoking as testosterone gel is flammable.
  • Ensure that you wash your hands after application and cover the application site with clothes.
  • Avoid people around you from touching the gel, especially women and children. This may cause unwanted hair growth and more aggressive behaviors in those who has contact with the gel.
  • Testosterone pills
  • This is an oral medication to be taken 2-3 times a day. In general, only a short treatment cycle is recommended as prolonged use of oral testosterone can lead to heart diseases, raised cholesterol level or even stroke.
  • Testosterone injections
  • Effects are instantaneous and a patient will only need to repeat the injection every 3 months. However, the injection may be painful to some.

Is Testosterone Replacement Safe?

Common side effects of testosterone replacement

  • Increase risks of heart disease, stroke, raised cholesterol and liver disease
  • Increase stickiness of blood and red blood cell concentration, leading to  increased risk of blood clotting
  • Causes enlarged prostate
  • Acne

As testosterone replacement can promote and increase the growth of prostate tissue, the treatment may not be suitable in men with prostate cancer or if they have an enlarged prostate.

When you are on testosterone replacement, it is important to follow up regularly with your doctor. Your doctor will monitor your condition closely and conduct frequent blood tests to watch for side effects.

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