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16 September, 2019 00:00 00 AM

Andropause

HealthCommunities.com
Andropause

Andropause, also sometimes called male menopause, is an acquired type of hypogonadism caused by the gradual decline of testosterone levels as a result of normal aging. Hormone levels vary throughout life in men and in women and levels of certain hormones, including sex hormones (e.g., testosterone, estrogen, progesterone), dehydroepiandrosterone (DHEA), human growth hormone (HGH), and melatonin, decline naturally with age.

In women, menopause usually occurs around the age of 50, when the ovaries stop producing female sex hormones (e.g., estrogen, progesterone) and menstrual cycles end. In men, production of the male sex hormone testosterone declines gradually beginning about age 30 and may reach low levels by 40–55 years of age.

In addition, levels of a chemical called sex-binding hormone globulin (SHBG) increase, further reducing the amount of bioavailable testosterone in the body. Bioavailable testosterone, which is not bound in the body by this chemical, maintains energy levels, healthy mood, fertility, and libido (sex drive). Some studies have shown that testosterone levels in men decrease up to 40% by the age of 70.

Low testosterone levels associated with andropause can cause a number of symptoms, including fatigue, diminished libido (sex drive), reduced energy levels, weakness, and psychological symptoms, such as mood swings, irritability, and depression. The condition also may increase the risk for heart disease (atherosclerosis) and bone loss (osteoporosis).

Older men who experience andropause symptoms should contact a physician for proper diagnosis and treatment. It is important to rule out conditions not related to normal aging, such as infection or tumors. Andropause diagnosis involves serum and blood tests. In some cases, hormone replacement therapy (HRT) is used to treat the condition, although this treatment carries some risks and is somewhat controversial.

Lifestyle changes also may be helpful to reduce symptoms and risks associated with andropause. Men with low testosterone levels should eat a healthy diet, maintain a healthy weight, get adequate amounts of sleep, exercise regularly (Check with your doctor before beginning an exercise program.), reduce stress, and limit alcohol intake, and should not use tobacco products.

Signs and Symptoms

Signs depend on the age of onset and the duration of hormonal deficiency. Congenital testosterone deficiency is generally characterized by underdeveloped genitalia (testes that do not descend into the scrotum) and, occasionally, undeterminable genitalia.

Acquired testosterone deficiency that develops near puberty can result in enlargement of breast tissue (gynecomastia), sparse or absent pubic and body hair, and underdeveloped penis, testes, and muscle.Adult men may experience diminished libido, erectile dysfunction, muscle weakness, loss of body hair, depression, and other mood disorders. Recent research has shown that about 30% of men who are diagnosed with depression may actually have hypogonadism.

Although testosterone primarily is a male hormone, it is also produced in the adrenal cortex in females. Testosterone deficiency that develops in girls during childhood delays puberty and often results in short stature, absence of menstruation (amenorrhea), and underdeveloped breasts.

Symptoms of testosterone deficiency in women include the following:

Absence of menstruation

Diminished sex drive (libido)

Hair loss

Hot flashes

Complications

Testosterone deficiency has been linked to muscle weakness and osteoporosis. In one study, proximal and distal muscle weakness was detected in 68% of men with primary or secondary hypogonadism.

Spinal, trabecular, and radial cortical bone density may also be significantly reduced in testosterone-deficient men. Thirty percent of men with spinal osteoporosis have long-standing testosterone deficiency, and one-third of men have subnormal bone density that puts them at risk for fracture.

Diagnosis

Serum and blood testing is done to determine the availability of testosterone and levels of leutenizing and gonadotropin-releasing hormones in the body. Men with low testosterone in whom normal or high gonadotropin levels are found typically have primary testosterone deficiency, which stems from a problem in the testicles.

Secondary and tertiary types, caused by problems of the hypothalamus or pituitary gland, often result in low testosterone and low gonadotropin levels.

Other tests involve injecoting GnRH or clmiphene citrate (an estrogen) to stimulate a diagnostic response within the hypothalamic-pituitary gonadal axis.

Rarely, testicular biopsy is done, usually in cases where sperm is absent from ejaculate despite normal testicle development. Biopsy, which involves using a needle to collect a sample of testicular tissue, may detect a malfunction in sperm production.

Treatment

Treatment involves hormone replacement therapy. The method of delivery is determined by age and duration of deficiency. Oral testosterone is associated with liver toxicity and liver tumors and so is prescribed sparingly.

Treatment for adults is aimed at maintaining secondary sex characteristics, improving energy, strength, mood, and feelings of well-being, and preventing bone degeneration. Modes of delivery include transdermal, mucoadhesive, and intramuscular injection.

Transdermal delivery (i.e., through the skin) with a testosterone patch is becoming the most common method of treatment for testosterone deficiency in adults. It establishes and maintains adequate serum levels in as many as 92% of men treated, without causing significant side effects.

A patch is worn, either on the scrotum or elsewhere on the body, and testosterone is released through the skin at controlled intervals. Patches are typically worn for 12 or 24 hours and can be worn during exercise, bathing, and strenuous activity. Two transdermal patches that are available are Androderm® (nonscrotal) and Testoderm® (scrotal).

The transdermal patches patches are applied to the abdomen, lower back, thigh, or upper arm and should be applied at the same time every evening between 8 p.m. and midnight. If the patch falls off before noon, replace it with a fresh patch until it is time to reapply a new patch that evening. If the patch falls off after noon, do not replace it until you reapply a new patch that evening.

The most common side effects associated with transdermal patch therapy include itching, discomfort, and irritation at the site of application. Some men may experience fluid retention, acne, and temporary abnormal breast development (gynecosmastia).

The When used properly, these gels deliver testosterone for 24 hours. The gel must be allowed to dry on the skin before dressing and must be applied at least 6 hours before showering or swimming. Gels cannot be applied to the genitals.

Gel is available in a metered-dose pump, which allows physicians to adjust the dosage of the medication. Side effects of transdermal gels include adverse reactions at the site of application, acne, headache, and hair loss (alopecia).

Mucoadhesive delivery allows testosterone to enter the bloodstream directly, bypassing the gastrointestinal tract and the liver.

Testosterone buccal system mucoadhesive CIII is a hormone-replacement treatment that delivers testosterone twice daily through a tablet-like buccal system that adheres to the gum or cheek. It is placed in the mouth where the gum meets the upper lip and dissolves into a gel that remains in place for 12 hours. As the product absorbs moisture, it gradually releases testosterone directly into the bloodstream, bypassing the gastrointestinal tract and the liver. In clinical trials, approximately 87% of patients obtained normal testosterone levels using Striant®.

Side effects are usually mild and transient (i.e., come and go) and resolve within 2 weeks. They include gum or mouth irritation, pain, and swelling (edema); bitter taste, and headache. Abnormal breast development (gynecomastia) may also occur. Patients should report persistent gum abnormalities to their physician.

transdermal patches should not be used in men with prostate or breast cancer and should be used with caution in patients with chronic heart, kidney, liver, or lung disease. It may cause edema, congestive heart failure, and sleep apnea, and may increase the risk for enlarged prostate and prostate cancer.

Patients taking the medication must undergo regular digital rectal examinations (DRE) and prostate-specific antigen (PSA) tests to monitor for signs of the disease.

Intramuscular injection (IM) is used less frequently because it is associated with erratic testosterone levels. The primary adverse effect associated with injected testosterone involves fluctuating mood, energy level, and libido caused by testosterone levels that rise rapidly upon injection and then fall too low before the next dose.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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