Male Menopause?
July 1, 2005
Richard S. Ferri, PhD, ANP, ACRN, FAAN
Freelance Editor, Medscape

The medical profession has been debating whether male menopause exists for decades. There is still no confirmed answer. However, there is clinically based evidence that natural hormone changes in men start around 40 years of age and advance with age. As men become older, serum testosterone levels can decrease to such low levels that hypogonadism results. Androgen deficiency in the aging male, known commonly as andropause consists of a constellation of symptoms.[1]

The symptoms of andropause include mood changes, fatigue, and increased facial wrinkling in addition to decreased sexual function, intellectual activity, lean body mass, muscle tone and strength, body hair, and bone mineral density resulting in osteoporosis.[2]

Clinicians should perform a careful history and physical examination with the appropriate laboratory screening. A complete blood count with differential should be obtained to assess for anemia and possible infectious processes. A comprehensive chemistry panel is needed to rule out any metabolic abnormalities. Also, free testosterone levels need to be measured to assess the available (unbound) testosterone in the body.[3]

The results of free testosterone measurement can vary widely among laboratories because of the way the tests are preformed. What is important is to know the range for the laboratory your patient is using, and making certain that the patient uses the same laboratory for all testing. Treatment of andropause may include hormone replacement therapy with testosterone gels or patches. Injectable testosterone is also available but can be painful and inconvenient.

The way in which androgen replacement may affect prostate health is a matter of concern. No evidence currently supports a causal relationship between appropriate androgen replacement therapy and prostate cancer.[4] However, in 2003 the National Institute of Medicine (IOM) began a long-term study to examine this issue. The study is longitudinal, and the results are not yet known. The IOM reminds clinicians always to discuss the possibility of a link between prostate hearth and testosterone replacement and to examine the prostate.[5] Testosterone replacement therapy, when given appropriately, has few and mild side effects. However, when testosterone is abused (eg, the current baseball scandal), side effects can include aggression ("roid rage"), acne, and insomnia. The most effective treatment in an abuse situation is to withdraw the drug, provide mild sedation if needed, and refer to a counselor.

In my experience, testosterone replacement in men with a physiologic need has not resulted in any negative effects. In fact, I have always been impressed on follow-up visits when men tell me how much better they feel, that their sex drives have increased, and that they feel "like themselves again."

However, simply increasing testosterone levels may not relieve the patient of all his symptoms. You may also have to screen and treat for depression and erectile dysfunction.

References [list=1][*]Gooren L. Androgen deficiency in the aging male: benefits and risks of androgen supplementation. J Steroid Biochem Mol Biol. 2003;85:349-55. Available at: . Accessed May 22, 2005. [*]Turek PJ. Androgens and the aging male. Available at: . Accessed May 22, 2005. [*]Editorial team. Male menopause -- a patient's guide. Available at: . Accessed May 22, 2005. [*]Morales A. Androgen replacement therapy and prostate safety. Eur Urol. 2002;41:113-120. Abstract available at: . Accessed May 22, 2005. [*]Institute of Medicine. Testosterone and aging: clinical research directions. Available at . Accessed June 1, 2005 [/list:o]