Wild, Wacky and Wonderful: Andropause

Andropause (or male menopause^[1]) is a somewhat misleading term which is sometimes used to describe a reduction of the production of certain hormones such as testosterone and dehydroepiandrosterone, and the consequences of that reduction,^[2] which is associated with a decrease in Leydig cells.^[3]^[4]

The term andropause is misleading (as is the term "male menopause"), because it suggests an equivalence with menopause, a complete and permanent shutting down of the reproductive system, which occurs only in women.

The term "andropause" is used in peer-reviewed journal articles, both with and without scare quotes; however, there is on-going professional disagreement about whether or not andropause should be considered a normal "state" (the term used by MeSH), or a disorder. A decline in testosterone level with age is well documented,^[5] but there is disagreement over how exactly a "normal" or "healthy" state should be defined.

Researchers who oppose the use of the term "andropause" may not object to the more limited terms "SLOH" or "ADAM", described in more detail below.

Andropause as a "state"

The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers^[6] identified symptoms of what they labeled the "male climacteric" including loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. Heller and Myers found that their subjects had lower than normal levels of testosterone, and that symptoms improved dramatically when patients were given replacement doses of testosterone.

Andropause has been observed in association with Alzheimer's disease.^[7]

In one study, 98.0% of primary care physicians believed that andropause and osteoporosis risk were related.^[8]

The term "symptomatic late onset hypogonadism" (or "SLOH") is sometimes considered to refer to the same condition as the word "andropause".^[9] ^[10]

Some researchers prefer the term "androgen deficiency of the aging male" ("ADAM"), to more accurately reflect the fact that the loss of testosterone production is gradual and asymptotic^[11] (in contrast to the more abrupt change associated with menopause^{[citation needed]}.) The "D" is sometimes given as "decline" instead of "deficiency".^[9] In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.^[12]

Andropause as a "disorder"

Proponents

Its proponents claim that it is a biological change experienced by men during their mid-life, and often compare it to female menopause. Menopause however is a complete cessation of reproductive ability caused by the shutting down of the female reproductive system in its entirety. Andropause is a diminishment of the male hormone testosterone. This drop in testosterone levels is considered to lead in some cases to loss of energy and concentration, depression, and mood swings. Unlike menopause, andropause does not cause a man's reproductive system to stop working altogether in mid-life, but many will experience bouts of impotence.

Some of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond.^[13] According to Diamond's view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, generally between the ages of 40 and 55, though it can occur as early as 35 or as late as 65. The term "male menopause" may be a misnomer, as unlike women, men's reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives (at age 90 or older^[14]). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.^[15]^[16]^[17]

The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.^[18]

Opponents

Many clinicians believe that andropause is not a valid concept, because men can continue to reproduce into old age, and do not universally show the same dramatic drops in hormone levels that are characteristic of menopause in women. Others feel that andropause is simply synonymous with hypogonadism or low testosterone levels.^[17] Opposition is not limited to the US.^[19]

Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition as the cause. For example, people who are overweight may be misguided into treating a 'new illness' rather than addressing the lifestyle that lead to their being overweight. Similarly, energy levels vary from person to person, and for those people who are generally inactive, energy levels will automatically be lower overall.

While it is true that active and otherwise healthy men could in theory develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.

Unlike menopause, the term "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification.

Diagnosis

Although there is disagreement over whether or not andropause is a condition to be "diagnosed" and "treated", those who support that position have made several proposals to address andropause and mitigate some of its effects.

Morley emphasizes the importance of response to treatment, as well as testosterone level and identifiable symptoms.^[20]

Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise. ^[21]

Diamond (a lay person) believes that depression is one of the most common problems of men going through andropause, and feels it is greatly under-diagnosed in men, with serious consequences.^[22]