A Family Doctor's Tale - MALE MENOPAUSE

DOC  I HAVE MALE MENOPAUSE

Male menopause or andropause is a condition which is due to lack of or absence of testosterone in men especially at the age above 50 years .

There are two types of andropause found in adult men:
1.Normal hormone levels through puberty and adulthood with normal sexual development is presented with the rapid drop of testosterone levels around the age of 50
2.Psychological type of andropause occurs gradually with gradual drop of male hormones, DHEA and human growth hormones.
This usually occur in older patients such as in the 60 to 70 age group.

What are the causes of Male Menopause?
Common causes for male menopause are:
1.age related lowering of blood testesterone
2.injury to the testes and male reproductive system
3.Surgical removal of testes and male reproductive system due to cancer
4.auto-immune diseases such as systemic lupus erythrematosis
5.geneteic abnormalities which cause premature testicular failure such as chromosomal mosiacism
6.generalized vascular conditions such as diabetes
7.orchitis or infections of the testes such as mumps(which is fortunately almost eradicated by immunization)
8.heavy smoking reduce blood flow to testes
9.chemotherapy which destroy the production of male hormones
10.pituitary tumors which control the production of male hormones.

What are the symptoms and signs of male menopause?
Symptoms of andropause:
1.Tiredness, general weakness
2.Reduced libido
3.Reduced sexual potency
4.Hot flushes
5.Sleep problem
6.Joint pain
7.Irritability and anger
8.depression
9.Changes in skin and hair growth
10.Pre-aging

 How is the diagnosis of Male Menopause made?
Male menopause is a simple endocrine problem which causes the testosterone in the blood to diminish with age.
The diagnosis is made by measuring
1. free testosterone blood levels (mean=700ng/dl , range =300-1100ng/dl)
2. computing the free androgen index (FAI) (total testosterone x 100 /sex hormone binding globulin). (range=70-100%).
If the free androgen index is less than 50% , symptoms of male menoopause appears.
3.A comprehensive medical and psychological assessment should also be done

What is the treatment of Male Menopause?
Testosterone Replacement Therapy like the Hormone Replacement Therapy of female menopause is the main form of treatment:
1.Tablets:
Methyltestosterone (Android,Virilon,Testred, Oreton) 10mg,
Testosterone undecanoate (Restandol, Andriol) 40mg, essentially a testosterone in oil preparation (not available in the USA)
Mesterolone (Proviron) 25mg -- less potent
2.Transdermal therapy
Testosterone--transdermal (Testoderm, Testoderm TTS, Androderm)
3.Injections
Testosterone cyprionate 100mg/dl
Testosterone Propionate in oil 100mg/ml
Testosterone Enaanthanate 200mg/dl
The usual dose is 1cc injected weekly or bi-weekly. This method of administration removes the risk of liver damage which may be caused by oral methyl testosterone .
4.Sub dermal Pellets
Testosterone pellets for male hormone deficiencies are inserted under the skin and dissolve slowly over a period of approximately three to four months.

What are the risks?
1.Prostate cancer-- There is no evidence in the medical literature that testosterone replacement therapy increases the risk of prostate cancer.

2.Heart disease-- increasing male androgen levels would also increase serum cholesterol and serum LDL-Cholesterol levels. .
3.Liver Disease--the only orally available forms of testosterone for men contain methyl testosterone.
If used for sustained periods of time, it can damage the liver.

4.Suppression of testicular function-- whenever any hormone is administered, the gland which normally produces it ceases to function.
Patients with borderline low testosterone levels may commit themselves to lifelong therapy if they start with testosterone replacement.

What are the benefits?
The administration to testosterone to men with true testosterone deficiency states will improve their health and sense of well being.