Andropause – Causes And Symptoms Of Hormone Deficiency

The term andropause is used in medicine to refer to age-related transformations of the hormonal background in the stronger sex. The International Society for the Study of the Problems of Older Men (ISSAM) defines this condition as a biochemical syndrome, which is characterized by a decrease in the concentration of androgens and, in some cases, receptor sensitivity to them.

Symptoms of testosterone deficiency usually occur in 45-50 years. Physiological changes in the body affect well-being, mood, and sexual life. Andropause differs from female menopause in less dramatic way. All changes occur smoothly and are not always obvious to the man himself.

Testosterone Level Dynamics

The concentration of androgens in the blood of healthy boys and young men increases from birth to 20-25 years. At the time of peak, testosterone levels in some representatives of the stronger sex approach the upper limits of the norm, while in others it is at lower physiological values. By the concentration of androgens, one can judge the sexual constitution of a man (weak, medium or strong). This indicator also helps predict the onset of andropause. After 30 years, every year the level of testosterone in the blood begins to decline at an average rate of 1-2% per year. With a low peak value of the hormone in 20-25 years, the onset of androgen deficiency can occur at 35-45 years of age. If the initial testosterone levels were high, then absolute andropause may not occur even after 65 years.

Studies show that andropause develops in 30-40% of men aged 35-70 years. The younger the group, the lower the prevalence of male menopause. For example, in people aged 40-45, age-related testosterone deficiency is observed in 34% of cases, and after 75 years, in almost half of all cases.

Key risk factors for early andropause:

    • weak sexual constitution;
    • excess weight or obesity;
    • diabetes;
    • hypertonic disease;
    • dyslipidemia (increased lipids in the blood);
    • atherosclerosis;
    • bad habits, etc.
Unfavorable external factors and serious diseases bring the onset of andropause in men closer. Testosterone deficiency in such cases is formed 5-10 years earlier.

Why does androgen deficiency develop?

Age-related decrease in the concentration of male hormones is a natural process. Testosterone deficiency is associated with a decrease in hormone secretion in the testes and with an increase in the level of sex-binding globulin (CVG) in the blood.

CVG is a protein that combines with sex hormones. It is more focused on androgens. The higher the level of this transport globulin, the less active testosterone acts on the tissue. In addition, as the concentration of SSH increases, the relative prevalence of estrogen increases. So, the effects of these female hormones are amplified.

The main causes of andropause:

    • a decrease in the number of Leydig cells in the testes;
    • a decrease in sensitivity to the pituitary luteinizing hormone;
    • decreased activity of steroidogenesis enzymes;
    • failures in the regulation of the hypothalamic-pituitary system;
    • genetic predisposition.

Classification of androgen deficiency

The decrease in the functional activity of Leydig cells in the testes occurs over the years in 100% of men. Sooner or later, testosterone deficiency affects every man. But in some, the level of androgens will fall below normal values, while in others it will remain within acceptable limits.

Depending on the severity of a decrease in hormone secretion, there are:

    • absolute deficit (hypogonadism, total blood testosterone – less than 12 nmol / l);
    • relative deficiency (decrease in hormone compared to the previous period, total testosterone is normal).

The absolute lack of male sex hormones may be accompanied by increased production of gonadotropins in the pituitary gland. An excess level of follicle-stimulating (FSH) and luteinizing (LH) hormone is a normal feedback reaction. Gonadotropins stimulate the testes. Such hypogonadism is called primary (testicular, hypergonadotropic), when the function of the testicles for the production of sex hormones is insufficient.

If there is no normal reaction of pituitary cells (LH and FSH are not elevated), then they speak of a secondary (central, hypogonadotropic) testosterone deficiency, when hormone deficiency is caused by insufficient activity of gonadotropic hormones that stimulate testicular function.

The prevalence of secondary hypogonadism decreases with age. If up to 50 years, this form of the disease accounts for almost 100% of the androgen deficiency, then after 70 years it is only about 10%.

Signs of andropause

Symptoms of a critical decrease in testosterone levels are diverse. Complaints concern the psychological and physical condition, sexual life.

Sexual sphere

Signs from the sexual sphere:

    • decreased drive;
    • worsening erection;
    • ejaculation disorders;
    • orgasm disorders;
    • infertility;
    • gynecomastia.

In a psycho-emotional state, anxiety and depressive disorders, sleep disturbances, chronic fatigue, and cognitive dysfunction can be observed.

Vegetative system

Patients often have symptoms of autonomic failure:

    • jumps in blood pressure;
    • arrhythmia;
    • sweating
    • cardialgia;
    • “Heat” in the body, etc.

Metabolism

Androgen deficiency affects metabolism.

For men with age-related testosterone deficiency is characteristic:

    • obesity;
    • decrease in bone mineral density (osteopenia and osteoporosis);
    • decrease in muscle mass;
    • dryness and sagging skin;
    • anemia.
In addition to these pathologies, patients often develop prostate diseases.

Diagnosis of andropause

Screening for androgen deficiency is recommended for all men over 50. To identify a testosterone deficiency in the first stage, simple questionnaires are used.

Other indications for studying the level of androgens:

    • erectile dysfunction;
    • infertility;
    • osteoporosis;
    • obesity;
    • diabetes;
    • renal failure, etc.

The examination can be carried out by a urologist, andrologist, endocrinologist and doctors of other specialties.

Diagnosis of andropause includes 3 stages:

    • questionnaire, medical history, examination;
    • analysis for the level of total testosterone;
    • determination of CVH (if the clinical picture of andropause is combined with a normal level of total testosterone).

Differentiate age-related testosterone deficiency with other diseases of the endocrine system, urogenital and somatic pathologies.

Treatment of andropause

There are two approaches to the treatment of andropause: replacement and stimulating hormone therapy. Regardless of the method chosen, treatment should pursue certain goals.

The goals of therapy:

    • reduce negative symptoms;
    • restore libido, erection and ejaculation;
    • remove psycho-emotional disorders;
    • reduce the manifestations of autonomic dysfunction;
    • increase the percentage of muscle mass;
    • to prevent osteoporosis and atherosclerosis;
    • compensate for dyslipidemia;
    • lower body mass index.
During hormone therapy, it is recommended to maintain the level of total testosterone in the range of 10-35 nmol / l.

Hormone replacement therapy

Testosterone replacement therapy consists of introducing exogenous testosterone into a man’s body. This method is most popular because it has been sufficiently studied (the first hormonal preparations of testosterone were obtained in the 40s) and is effective in any form of hypogonadism.

Androgen replacement therapy is contraindicated in:

    • prostate cancer;
    • breast cancer
    • severe pathology of the heart, liver and kidneys;
    • planned paternity;
    • gynecomastia of unknown etiology;
    • sleep apnea, etc.

For combination therapy of erectile dysfunction, type 5 phosphodiesterase inhibitors (vardenafil, sildenafil, tadalafil) are added to hormonal drugs.

Stimulating hormone therapy

Chorionic gonadotropin therapy stimulates the production of testosterone in Leydig cells. This method is effective only if the function of the testicles is preserved, i.e., with secondary hypogonadism. Also, these medications improve spermatogenesis. Chorionic gonadotropin is produced as a solution for injection. Typically, the patient needs 1 injection in 5-10 days. Doses of the drug are selected strictly individually.