Coming to terms with ‘andropause’

Do you feel a decline in erectile function? Do you experience lesser orgasms? Are you going through a decrease in sexual thoughts and enjoyment?

If you answered yes to at least two of the three questions and are not suffering from any disease, then you are probably a man who is 50 years old or older.

If older women can suffer from menopause, medical experts say that aging males can also go through "andropause," a decline in a man’s gonadal functions.

This means that as a man grows older physiologically, he becomes less functional and is exposed to greater risk of diseases. Among the problems faced by the aging male are increasing morbidity and mortality, chronic disabling conditions and chronic decreasing mental prowess.

Dr. Khalid Abdul Kadir, professor of medicine at the Universiti Kebangsaan Malaysia, Pantai Medical Center, explained that among other things, the aging male is at increased risk of cardiovascular disease due to age and gender.

A 1995 World Health Organization (WHO) Study Group stated that for men, the risk of cardiovascular death increases two-fold after 65 years old. This risk is a 50 percent increase as compared to women.

Khalid, the keynote speaker during the recent Philippine Society for the Study of the Aging Male (PhiSSAM) convention, attributed this to decreasing levels of several hormones: growth hormone, insulin and testosterone.

Lower testosterone levels seen in elderly men are associated with abdominal obesity or increased waist-hip ratio (an independent risk factor for cardiovascular diseases), and thus, increases cardiovascular risk in aging males.

Andropause (or male menopause) is associated with a decrease in libido and lean body mass, muscle strength, bone density and sexual function, along with changes in mood and cognition.

Unlike menopause in women where there is an absolute estrogen deficiency, the decrease in biologically active androgen levels in andropause is gradual. Testosterone levels start declining at age 50 with the lowest levels seen in men 70 years old and older.

Among the symptoms associated with andropause are mood swings, loss of concentration and reduced energy. Although not every man experiences the daily symptoms of andropause, many men may be at risk of the silent effects linked to low testosterone levels such as osteoporosis and increased cardiovascular risk.

Testosterone is necessary for libido, erectile function and normal ejaculation. Bioavailable testosterone levels correlate strongly with nocturnal penile erections, especially in men aged 55 to 64.

Interestingly, estrogen, the female hormone, which men also have in small quantities, may have a role in determining sexual function in men.

Testosterone also has antidepressant properties. In hypogonadal men, testosterone replacement improves mood and sense of well-being, reduces anxiety and improves concentrating ability.

In a cross-sectional study of 856 men, bioavailable testosterone levels were inversely associated with depression. High levels of testosterone are also associated with better mental control and long-term verbal memory.

Treatment for andropause is testosterone replacement therapy (TRT), which can either be in the form of oral tablets, injectables, transdermal patches, gel and implants.

In the Philippines, only the oral TRT is available, and testosterone undecanoate (TU) is said to be the most effective since it is unmodified and thus, is very similar to the natural testosterone.

Testosterone undecanoate is free of liver toxicity because it circumvents first passage through the liver, and to enable it to be absorbed via the lymphatic system, it must be taken with meals. Oral TRT is found to improve general well-being, bone mineral density and body composition.

It is best to consult your doctor early when you start feeling the symptoms. Don’t delay, or suffer from the symptoms in silence.