Andropause – Causes, Symptoms and Treatment
Andropause refers to the age-related decline in testosterone levels in men, typically beginning around age 40. It can cause symptoms such as fatigue, reduced libido, and mood changes.
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Andropause refers to the age-related decline in testosterone levels in men, typically beginning around age 40. It can cause symptoms such as fatigue, reduced libido, and mood changes.
What Is Andropause?
Andropause – also referred to as the male climacteric or late-onset hypogonadism – describes the gradual, age-related decline in the male sex hormone testosterone. Unlike the female menopause, this process in men is slow and progressive, unfolding over many years. Early changes can begin as early as age 40, becoming more common after age 50.
Causes
The primary cause of andropause is the natural, age-related reduction in testosterone production by the Leydig cells in the testes. From around the age of 30, testosterone levels in men decline by an average of 1–2% per year. Additional contributing factors include:
- Obesity and metabolic syndrome
- Chronic stress
- Sleep deprivation and sleep disorders
- Underlying conditions (e.g., diabetes mellitus, thyroid disorders)
- Certain medications (e.g., corticosteroids, opioids)
- Genetic predisposition
Symptoms
The symptoms of andropause are diverse and non-specific, which is why they are often not immediately associated with low testosterone. Common complaints include:
- Sexual symptoms: reduced libido, erectile dysfunction, decreased ejaculate volume
- Physical symptoms: fatigue, loss of muscle mass and strength, increased body fat (especially abdominal), bone density loss (osteoporosis)
- Psychological symptoms: mood swings, irritability, depressive episodes, difficulty concentrating, and memory problems
- Other symptoms: hot flashes, night sweats, sleep disturbances, reduced body hair growth
Diagnosis
Diagnosis of andropause is based on a combination of symptom assessment and laboratory testing. A physician will first take a thorough medical history and evaluate the symptoms, often using standardized questionnaires such as the AMS (Aging Males Symptoms) Scale. Blood tests are then performed to measure:
- Total testosterone (normal range: 12–35 nmol/L)
- Free testosterone
- LH (luteinizing hormone) and FSH (follicle-stimulating hormone)
- Other hormones such as SHBG (sex hormone-binding globulin)
Testosterone deficiency is generally diagnosed when total testosterone falls below 12 nmol/L in combination with typical symptoms.
Treatment
Lifestyle Modifications
As a first-line approach, lifestyle changes can help stabilize testosterone levels naturally:
- Regular physical activity, particularly strength and endurance training
- Weight loss in overweight individuals
- A healthy, balanced diet
- Stress reduction and adequate sleep
- Reduction of alcohol and tobacco consumption
Testosterone Replacement Therapy (TRT)
In cases of confirmed testosterone deficiency with significant symptoms, testosterone replacement therapy (TRT) may be considered. It is available in several forms:
- Gels: applied daily to the skin
- Injections: intramuscular, every 2–12 weeks depending on the preparation
- Patches: applied daily to the skin
- Capsules: taken orally
TRT should always be carried out under medical supervision, as it carries risks including stimulation of prostate growth, polycythemia (elevated red blood cell count), and cardiovascular side effects. Prostate cancer must be ruled out before initiating therapy.
References
- Bhasin S. et al. – Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2018; 103(5): 1715–1744.
- Nieschlag E., Behre H.M. – Testosterone: Action, Deficiency, Substitution, 4th edition, Cambridge University Press, 2012.
- World Health Organization (WHO) – Global status report on noncommunicable diseases. WHO Press, Geneva, 2014.
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