Dr. Qaadri

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Andropause, Testosterone checklist

By Dr. Shafiq Qaadri, MD

Andropause (‘menopause for men’) is a valid clinical entity gaining more attention, though the diagnosis is still controversial. It is the subject of numerous studies and international conferences, and the diagnosis is now being used by psychiatrists, endocrinologists, and urologists. However, the andropause symptom complex needs to be more widely appreciated by family physicians.

The male experience of andropause is not as acute or florid as female menopause, and there are no markers such as the cessation of periods.

What are the tests?
There is no definitive test, although free (bioavailable) testosterone levels may be somewhat of a guide.
It is recommended that patients be screened with a full hormone profile, which includes TSH, FSH, LH, and Prolactin levels.

A presumptive diagnosis of the andropause syndrome is made after a thorough history, physical examination, and bloodwork, but it is still a global subjective impression.

Clinical Manifestations:

Lethargy, low mental energy, decreased capacity to make decisions
Sadness, grumpiness
Unusual fright and anxiety
Decreased sense of wellbeing
Pessimism, proneness to solitude, difficulties with short-term memory

Erection weakness
Decreased quality of orgasm
Decreased sensitivity
Decreased interest or desire for sex leading to decreased sexual
performance and activity

Flushing, sweats

Loss of sexual body hair
Frequent joint and muscle aches
Increased obesity
Decreased vigour and physical activity
Diminished muscle mass and strength

Who gets Andropause?
Testosterone levels in men start declining by age 30, by 5% every five years.
Men have been symptomatic from as early as the 30s, to as late as the 70s.
It is estimated that 30% of men over the age of 50 might qualify for an andropause diagnosis. All will not necessarily require intervention.

Patient Questionnaire:

Do you have a decrease in libido (sex drive)?
Do you have a lack of energy?
Do you have a decrease in strength and/or endurance?
Have you lost height?
Have you noticed a decreased enjoyment of life?
Are you sad and/or grumpy?
Are your erections less strong?
Have you noted a recent deterioration in your ability to play sports?
Are you falling asleep after dinner?
Has there been a recent deterioration in your work performance?

Osteoporosis in men

A neglected area in men, but also gaining attention.

Many endocrinologists are using TRT and/or bisphosphonates to treat male osteoporosis.

Standardized data, even bone densitometry in males, needs to be improved with sex-specific information.

A new term
TRT: Testosterone Replacement Therapy. The male version of HRT, TRT comes in many forms: pills, patches, gels and injections.

It is difficult to distinguish andropause from clinical depression, as many of the same biopsychosocial factors are found.

One should screen aggressively for a mood disorder, as there is considerable overlap.
Some patients are being treated with combinations of new-generation antidepressants and Testosterone Replacement Therapy (TRT).

A controversial area is the possible link of long term TRT and prostate cancer—either unmasking existing prostate cancer, or causing new cancers. Thus men on TRT must be screened and monitored for prostate cancer rigorously.

Andropause is the clinical manifestation of declining androgen levels in the aging male. Androgen deficiency in the Aging Male (ADAM) is the one of the diagnostic terms.

There is a wide age-range that men may experience symptoms, usually from their 40s to 70s. Symptoms include physical, psychological, and sexual difficulties.

Testosterone declines in all men, but thresholds vary for symptoms. Starting at approximately age 30, levels decline by 5% every five years.

Free (bioavailable) testosterone measurements are only a guide; the diagnosis is based on a subjective global impression.

Some men benefit from Testosterone Replacement Therapy (TRT), though prostate cancer potential must be monitored closely.

Though less common, some patients experience a chemical andropause secondary to an endocrinopathy, such as a prolactin-secreting tumor.

Dr. Shafiq Qaadri is a Toronto family physician and Continuing Medical Education lecturer. www.doctorQ.ca

Qaadri, S. 'When men go through The Change,' The Globe and Mail, Ed. Joan Ramsay. January 22, 2002.

Casey, Richard (Ed.) et al. Journal of Sexual & Reproductive Medicine, Autumn 2001.

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