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  Andropause
 
Authors: Adrian Dobs, Shehzad Basaria, MD Last modified: January 3, 2002
DIAGNOSTIC CRITERIA

  EPIDEMIOLOGY

  • Andropause or viropause is the decline in testosterone levels in men with aging.
  • Testosterone levels decrease in men from the age of 40.
  • The decline in testosterone levels after this age is 110 ng/dl every decade.
  • With aging there is an increase in SHBG levels and therefore the decline in free testosterone levels is even higher.

  RISK FACTORS

  • Older age - declines in testoterone may begin in the 4th decade of life.
  • Andropause occurs as a result of both central (pituitary) and peripheral (testes) defect in the androgen axis.
  • With aging there is a decline in pulse amplitude of GnRH secretion and a decrease in testicular response to GnRH or HCG injection.

  SIGNS AND SYMPTOMS

  • Erectile dysfunction, decreased libido
  • Loss of height, osteopenia, osteoporosis, fractures.
  • Depression, decreased energy
  • Decrease in muscle mass and strength. Increase in fat mass.
  • Decrease in body hair.
  • Decrease in overall quality of life.
  • Anemia.

  DIFFERENTIAL DIAGNOSIS

  • Hypogonadism from a pituitary tumor, hyperprolactinemia, primary gonadal failure from chemotherapy or radiation therapy
  • Clinical depression
  • Drug-induced hypogonadism: opiates.

  LABORATORY FINDINGS

  • Low serum total testosterone. Greater decline in free and bioavailable testosterone.
  • Inappropriately low or normal FSH and LH
  • Decreased hemoglobin and hematocrit
  • Osteoporosis on Dexa scan.
  • MRI - no evidence of a pituitary or hypothalamic mass
 
TREATMENT
TESTOSTERONE REPLACEMENT THERAPY
  • Patches - Androderm 2.5 - 7.5 mg daily q hs, Testoderm 5-10 mg daily
  • Gels - Androgel 5-10 gm daily to skin
TREATMENT FOR OSTEOPOROSIS
  • Calcium 1500 mg daily, vitamin D 400 units daily, alendronate 70 mg weekly, risidronate 30 mg weekly
 
IMPORTANT POINTS/RECOMMENDATIONS
  • Prior to initiating any form of testosterone replacement therapy men should have a normal serum PSA and digital rectal exam to rule out prostate cancer
  • Hemoglogin and hematocrit levels need to be monitored closely beofre and during therapy due to the eyrthropoietin stimulating effects of testosterone. Testosterone dose should be decreased if Hct>52%.
  • Bone density should be measured on a yearly basis.
 
REFERENCES
  1. Korenman S, Morley JE, Mooradian AD, et al. ;  Longitudinal changes in testosterone, luteinizing hormone, and follicle-stimulating hormone in healthy older men. ;  Metabolism. 1997;46:410-3.

  2. Hajjar R, Kaiser F, Morley JE. ;  Outcomes of long-term testosterone replacement in older hypogonadal males: a retrospective analysis. ;  J Clin Endocrinol Metab. 1997;82:3793-6.

  3. Tenover J. ;  Effects of testosterone supplementation in the aging male. ;  J Clin Endocrinol Metab. 1992;75:1092-8.

  4. Basaria S, Dobs AS. ;  Risks versus benefits of testosterone therapy in elderly men. ;  Drugs Aging. 1999;15:131-42.

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