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Andropause

Definition
Andropause is a condition that is associated with the decrease in the male hormone testosterone. It is unlike menopause in that the decrease in testosterone and the development of symptoms is more gradual than what occurs in women. Approximately 30% of men in their 50s will experience symptoms of andropause caused by low testosterone levels.

History
Sixteenth century Chinese text of Medicine provided a series of symptoms believed to be the male equivalent of menopause
In 1889, at age 72, distinguished French neurologist and physiologist Charles E Brown-Sequard reported in “Lancet” the rejuvenating effects of self-administered extracts of dog and guinea pig testes
Brown-Sequard administered five subcutaneous doses of extract prepared from dog testicles over a 3-day period. This was followed by five more injections of extract from guinea pig testes over the following 18 days. He reported in “Lancet”. “The day after the first subcutaneous injection, and still more after the two succeeding ones, a radical change took place in me… condition became quite manifest”
In 1935, Butenandt and Ruzicka received the Nobel prize in Chemistry after synthesizing testosterone in the laboratory
In 1946, Werner published a landmark paper in The Journal of the American Medical Association (JAMA) entitled “The male climacteric”. Climacteric is characterized by nervousness, reduced potency, decreased libido, irritability, fatigue, depression, memory problems, sleep disturbances and hot flushes
Epidemiology
Although all women undergo menopause, it is uncertain in every man experiences symptomatic decline in circulating androgen with aging. Prevalence of andropause caries extensively depending on the age group of the study population as well as the diagnostic criteria used. it has however been estimated that on the average, about 50% of healthy men above the age of 60 years have serum bioavailable testosterone levels that are below the lower limit of normal for men aged 20-40 years.

Risk factors
Diabetes
Premature andropause can occur in men who experience excessive female hormone stimulation through exposure to toxic estrogen look-alikes. Estrogen dominance is more common in men and women who drink recycled water, live near incinerators, work in the pharmaceutical industry, or live near plastics, dyes or other chemical factories, or on farms that use pesticides and other chemicals
Overweight (high BMI or body mass index)
Hypertension (high blood pressure)
Alcohol, especially regular or excessive use
Tobacco
Marijuana
Genetic disorders that produce hypogonadism, including Klinefelter’s, Wilson-Turner’s and Androgen insensitivity syndromes
Causes
Andropause is usually triggered by low testosterone. Testosterone is responsible for male physical characteristics such as body and facial hair, deep voice, muscle strength, strong sexual drive and competitive behaviour. The testes produce less testosterone as men age
However, certain medical conditions can also trigger early andropause, such as testicular cancer and the surgical removal of the testes. Prostate cancer patients who receive anti-testosterone therapy to maintain very low testosterone levels can also experience andropause
Symptoms
Physical

Baldness of head
Reduced body hair, especially axillary and pubic area
Decreased muscle mass and increased body fat
Reduced body strength and stamina
Feeling of weakness or tiredness
Decreased testicular size
Enlarged prostate
Urinary discomfort and/or difficulties
Backache, joint pains and stiffness
Cardiovascular

Increasing risk of heart attack
Increased levels of insulin, cholesterol and triglyceride
High blood pressure Diminished elasticity of coronary artery
Diminished strength of the heart muscle
Mental

Low or negative mood, feeling irritable and insecure
Inner unrest
Feeling overstressed
Lack of concentrating power
Memory deficits
Reduced intellect and critical thinking
Sexual

Decreased libido
Reduced organ sensitivity or pleasure
Impaired orgasms
Loss of erections or problems during sex

Diagnosis and test
To make the diagnosis of male menopause, the doctor will:

Perform a physical exam
Ask about symptoms
Order tests to rule out medical problems that may be contributing to the condition
Order blood tests, which may include measuring testosterone level
Treatment and medications                                                                               
Replacing testosterone in the blood is the most common treatment for men going through andropause: This treatment may provide relief from the symptoms and help improve the quality of life in many cases. Lifestyle changes such as increased exercise, stress reduction, and good nutrition also help. Your doctor will help you decide if testosterone treatment is right in your situation, as treatment does have risks.

Testosterone is available in a variety of different preparations including skin patches, capsules, gels, and injections: Your doctor will help determine which treatment is best for you and will often consider your lifestyle when making this decision. Follow-up visits with your doctor will be important after the initial treatment begins. At follow-up visits, your doctor will check your response to the treatment and make adjustments, if necessary.

Skin patches: People who wear a patch containing testosterone receive the hormone through the skin. The patch allows a slow, steady release of testosterone into the blood stream. It is applied once a day to a dry area of skin on the back, abdomen, upper arms, or thighs.

Testosterone gel: This treatment is also applied directly to the skin, usually on the arms. Because the gel may transfer to other individuals through skin contact, a person must take care to wash the gel from the hands after each application.

Capsules: Taken twice daily after meals, this is yet another option for testosterone replacement. Men with liver disease, poor liver function, serious heart or kidney disease, or too much calcium in their blood should avoid testosterone capsules.

Testosterone injections: This treatment involves injections of testosterone (testosterone cypionate* and testosterone enanthate) in the muscle every 2 to 4 weeks. They may cause mood swings due to changes in testosterone levels. Men with severe heart disease, severe kidney disease, or too much calcium in their blood should avoid testosterone cypionate. Men with severe kidney disease should not take testosterone enanthate.

Testosterone should not be taken by any man with prostate or breast cancer. If you have heart disease, are taking some medications such as blood thinners, have an enlarged prostate, or have kidney or liver disease, you will need to discuss with your doctor whether or not testosterone therapy is right for you.

Prevention
It is a fact that decline in testosterone levels with increasing age occurs in all men. Some current studies suggest that smoking and high cholesterol level may increase the risks for early andropause. Therefore, you should quit smoking and target at better cholesterol level control for prevention. Regular exercise will also help to maintain the muscle and bone mass.

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