Male Menopause: Are you at risk?

As men get older, there could be a drop in levels of certain male hormones called androgens, particularly testosterone, resulting in certain clinical symptoms and manifestations that are also sometimes referred to a condition called “male menopause” or “andropause”. Unlike women, testosterone levels depletion in men begin much early, as early as the age of 30, and continues to last for a longer duration of time. It is not a disease and is known differently as Partial Androgen Deficiency in Aging Males (PADAM) or Androgen Deficiency in Aging Males (ADAM) or Late Onset Hypogonadism (LOH) or Testosterone Deficiency Syndrome (TDS).

Male Hormones – An Overview

Hormones in general are the messengers in our body. They help in communication by transmitting signals and message from the brain to the various tissues of the body. Androgens are the hormones responsible for imparting masculine characteristics to men. They are responsible for the development and sustenance of both primary and secondary sexual characteristics in men. Testosterone is the main male sex hormone, produced primarily in the testes and circulated via blood throughout the body. The pituitary gland, controlled by the hypothalamus, is located in the brain and is responsible for co-ordination of the function of testes.

Deficient Androgen Levels

A deficiency in testosterone can results in one or more of a wide range of symptomatic conditions like:

• reduced libido (either with or without erectile dysfunction),
• unsustained or weaker erections and lower orgasms,
• lesser content of ejaculate,
• easy fatigue and lethargy,
• decreased energy or stamina levels,
• reduced muscle mass,
• reduced muscle strength,
• reduced bone mass,
• reduced body hair,
• development of gynecomastia (breast development in men),
• hot flushes with increased sweating,
• increase in body fat,
• increased body weight, especially around the hip and waist regions
• quicker irritability associated with or without depression.
• inability to concentrate
• poor memory
• sleep disturbances
• increased cholesterol and lipid levels
• decrease in hemoglobin levels, possibly leading to mild anaemia
• weak and fragile bones, possibly leading to osteoporosis
• more frequent mood swings.

Reasons for Androgen Deficiency

Among various causes, the main reasons for androgen deficiency are attributed to some problems associated with one or more of the following body organs:

Pituitary Gland: An adenoma in this gland may be responsible for stoppage of production
of gonadotropins (responsible for transmitting signals to the testes to produce testosterone).

Hypothalamus: Some congenital abnormalities or tumors can affect the functioning of the pituitary gland which would thereby affect testosterone production (by the mechanism mentioned above).

Testes: Some congenital conditions like Klinefelter’s syndrome (a rare genetic disorder in which there is an extra sex chromosome present) or other disorders that occur through a man’s life (like undescended testes, loss of testes due to accident, torsion or side effects of radio- or chemotherapy) can prevent the testes from producing testosterone.

Other factors like old age, obesity, alcoholism, smoking, hemochromatosis (excessive iron in the body), malnutrition and prevalence of cardiovascular and endocrine conditions like diabetes can play a major role in androgen deficiency.

Also lifestyle related changes like anxiety and stress can have an influencing role in the onset and magnitude of androgen deficiency.

Diagnosis of Androgen Deficiency

During the diagnosis, a series of history-taking with physical and pathological investigations will be carried out by the medical practitioner to ascertain at least the following information:

• Age at start of the deficiency
• Duration of the deficiency
• Seriousness of the deficiency
• Impact of the deficiency
• Genetic factors related to or responsible for the deficiency
• Lifestyle changes or trauma related to or responsible for the deficiency.

Treatment Options

There are various options for delivery systems available for the treatment of deficient testosterone levels. They range from intramuscular injections to orally administered pellets, tablets or capsules to external applications like transdermal patches and gels.There is also a replacement therapy often referred to as Hormone Replacement Therapy (HRT) or Testosterone Replacement Therapy (TRT). The option most suited will depend on a variety of factors like age, affordability, need and acceptability; and is best left to the medical practitioner to decide.

Lifestyle Options to Maintain Healthy “T” levels

Have a healthy balanced diet with a rich mix of vegetables, fruits, nuts and cholesterol rich (the good ones) food. Cholesterol will act as a carrier for testosterone. Sugars and trans-fat need to be avoided.

• Get active and opt for the stairs instead of the elevators.
• Hit the gym and let the body sweat out to a different exercise regimen daily. Pushing beyond limits does help. Vary the intensity and pace.
• Stay away from alcohol.
• Keep smoking at bay; not just active smoking, but also the passive smoking.
• Get a good night’s sleep.
• Get adequate amounts of vitamins and minerals, particularly Vitamins A, C, D, Magnesium and Zinc.
• Find ways and means to relax and de-stress. Get time-out for yourself.
• Engage in high intensity sports like running. There have been research findings that indicate high intensity running can boost testosterone and human growth hormone (HGH) levels.
• Get a routine health check done annually.