Testosterone values decrease annually, although individual differences may exist. Total Testosterone values decrease by 35% in men aged 20 to 80, while free Testosterone (Tl) decreases by 50%. It has been shown that with age there is a loss of heart rhythm (day-night) of the secretion of Testosterone, in the elderly, as well as an elevation of transporter globulins and therefore only 2% circulates freely to be used by cells of the body.
-What is Andropause and how does it manifest itself?:
The term Andropause is used only to parallel the feminine of menopause. These two entities are different in their physiology, evolution, prognosis and clinical effects. The androgenic deficit is gradual, occurs in 25 to 35% of men and there is only a partial deficiency of androgens, not significantly affecting their ability to fertilize in certain cases, which is completely opposite to the stage of menopause. The initiation of andropause is unpredictable and its manifestations are subtle and diverse. The terms synonyms
which can be used as a more appropriate definition of the phenomenon are:
-A.D.A.M. (Androgen Deficiency Adult Male) or
– L.O.H. (Late onset hypogonadism)
We refer to «Andropause» without this being a correct term just as we refer to «athlete’s foot». When describing the symptoms and signs of late hypogonadism, many feel identified with them, which explains their inespecificity and these can be presented by multiple factors (stress, hypothyroidism, sedentary life, sexual dysfunction, etc.) or, simply, by a physiological phenomenon linked to age.
-When does Andropause begin?
The term «Andropause», as we have already pointed out, is not a masculine equivalent of Menopause, we use it in a figurative sense to refer to the Testosterone Deficit Occurring in the Adult, in the male, there is no definitive cessation of the hormonal activity of the testicles, but from the age of 45 in more than 38% of men, hormone production can decline, in some cases even before and present sexual disorders, which can complicate the relationship.
In women, when what is known as Menopause occurs, it leads to the cessation of all activity of the ovaries and therefore menstruation, it does not happen suddenly, but is preceded by a period of at least one year of Perimenopause or transition phase, which runs from when the changes in the menstrual cycle begin until the period completely disappears, generally between 45 and 55 years and can be so early that occurs around 35 years.
-what causes it?
Several studies show that the passage of age is associated with a lower production of some hormones, especially sex steroids (androgens), growth hormone, melatonin and dihydroepiandrosterone (DHEA). There is a gradual decrease in testosterone over the years, but it is not comparable to the sudden drop in estrogen in women. This decrease is seen from 40-45 years and is a physiological decrease. Testosterone values, both total and bioavailable, decrease in healthy males by approximately 1 to 2% every year after the age of 30.
This decrease in plasma testosterone is due to changes in testicular tissue due to cell deterioration. The decrease in free testosterone is a consequence of the decrease in total testosterone production along with the increase in sex hormone-transporting globulin (SHBG) and therefore most importantly a decrease in available testosterone.
-When should we see a specialist?:
Generally the man is reluctant to consult, for fear that it is a sign of weakness, or think that their self-esteem, will be affected, however this attitude can have negative consequences on their relationship, as it may interpret low sexual performance as a sign of disaffection or infidelity, in this situation should be consulted the specialist.
The man who is in this state, manifest a loss of libido and sometimes erectile dysfunction and present as general symptoms: a negative image of himself, low tolerance to stress, anxiety and sleep disorders, easy tiredness and loss of vital energy, difficulty in concentration, all accompanied by loss of muscle mass with a tendency to osteoporosis and increased abdominal fat, all this polychromatism or constellation of manifestations, are strong reasons to consult a specialist.
How is the treatment?:
When, in certain men, and due to the sum of other predisposing factors, the clinical situation of hypogonadism becomes evident and has negative repercussions on physical and mental health, we consider them to be patients.
An early diagnosis and a correct treatment with the appropriate hormonal therapy will improve the psychic, physical and sexual aspects of the male. Men who, from 40-45 years of age, suffer with anguish the evident symptoms of andropause and feel more vulnerable, need the support of expert professionals in the field. substitutive treatment allows multiple routes of administration of testosterone that the doctor will choose according to the case or / and preference of the patient.
Oral: Methyltestosterone (25 mg daily) not recommended for hepatic metabolism.
Intramuscular: Propionate or Testosterone cypionate (250 mg. c/2- 4 weeks).
Testosterone Undecanate 1000 mg. deposit c / 3 months.
Dermal gel: 100 mg daily.
Transdermal patches: Daily 5 mg. Currently not available in our environment.
Can it be prevented?:
If there is some assurance that clinical signs and symptoms and testosterone values point to true late hypogonadism, substitution treatment is justified by adherence to treatment with good results.
Although similar results could be obtained with changes in diet, losing weight if there is obesity, exercises, not smoking and eliminating stress as some advise, but in this case there is a low percentage of performance and adherence to therapy.