Male Andropause: An overlooked condition

Written by pharmacist  |  22. November 2004

Andropause or hypogonadism is a natural decline in testosterone in males that begins to occur at the age of twenty-five with a steady decline thereafter with symptoms sometimes appearing in the mid-thirties. Testosterone levels will have dropped approximately 50% by the time a male is in his mid-forties. A reduction of this androgen results in several noticeable symptoms, lethargy, fogy thinking, increase in body fat composition and a decrease sex drive. Often these symptoms are treated with other means and not associated with a diminishing testosterone.
Testosterone is an essential male hormone. Testosterone levels are crucial for sexual functioning and play a major role in preventing osteoporosis and heart disease.
It is well established that proven hypogonadism can be managed successfully with testosterone replacement therapy, leading to increases in bone mineral density, lean body mass, muscle mass and strength, general well-being, mood and libido. There is a growing interest in the use of androgens in andropause, and new understanding of the role of testosterone and other androgens (DHEA) in the aging process is helping to define those patients who might benefit from testosterone therapy.
It is thought that most testosterone in the blood, about 65%, is strongly bound to sex hormone-binding globulin (SHBG), about 35% is bound relatively loosely to albumin and only 1-2% is free. It is increasingly accepted that the only testosterone that can be used by cells (termed 'bioavailable testosterone') is free testosterone plus albumin-bound testosterone. Bioavailable testosterone, as defined here, is sometimes also referred to as 'non-SHBG-bound testosterone'. Testosterone concentrations vary considerably between individuals, the normal range of total serum testosterone in young adult men being 12-35 nmol/L and bioavailable testosterone being 2.5-4.2 nmol/L Acquired hypogonadism Common causes of acquired hypogonadism include testicular trauma, obesity, acquired immune deficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), chronic liver disease, chronic renal failure, sickle cell disease, drug abuse and use of certain medications. For example, excessive alcohol use has a toxic effect on the Leydig cells of the testis, which is usually irreversible. Medications causally associated with hypogonadism include ketoconazole, anabolic steroids, corticosteroids, spironolactone, cimetidine, phenytoin and flutamide. Hypogonadism may also be caused by reduced blood flow to the testes, for example in case of atherosclerosis. Other aspects of a patient's medical record that are important include a history of mumps, cancer chemotherapy, irradiation of the testes, occupational risks, heat exposure of the testes, hemochromatosis, and cancer of the adrenals, testes or pituitary.
A bioidentical testosterone formulation that can be used by such patients is expected to provide relief from the symptoms of aging that are related to testosterone deficiency and be of great benefit to older men. Historically, testosterone was administered parentally using intramuscular injections, whereas more convenient administration routes transdermal patches and a transdermal gel preparation. The term bioidentical refers to the actual or naturally occurring testosterone normally produced by the body. Basically the sources are natural and are chemically exact to your hormone.
Ideally men should know their baseline testosterone levels in there early to mid-twenties so that levels can be corrected at a later age. However, this means is not always practical. Men over forty should see their doctors about getting a simple blood test to determine their testosterone ("Free" Testosterone), DHEA and SHBG. Initially a prostate exam is a good start before initiating any therapy. If therapy is started, a follow-up with your physician is a must at least 4-8 weeks afterwards with a repeated blood test.

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