Chicago, IL (PressExposure) July 02, 2009 -- Andropause: Its Signs, Symptoms and Treatment Options
What is âLow Testosterone?â Low testosterone, also called hypogonadism, occurs when the testes produce smaller amounts of testosterone than is considered a normal range. Not as well known a term as female menopause, Andropause, is the term for the naturally occurring drop in testosterone. A ballpark normal range for total testosterone in males is 300-1100ng/dl, with 700ng/dl being the mean. This site however quotes 437 to 707 ng/dl as a normal range. You should base your results on the lab that performed your tests range, not these. Regardless of the performing lab, your results appear to be low, particularly for the free testosterone value.
Another sources believe normal ranges to be: 15.0- 40.0 pg/ml as a normal range for free testosterone, and 300ng/dl 1,000ng/dl for total testosterone.
Free testosterone 50-210 pictograms per milliliter (pg/mL) and total testosterone 300ng/dl -1,000ng/dl
Clinicians should look at the level of free active testosterone (FAT) rather than total testosterone to get an accurate reading. Measuring FAT is much more accurate. Additionally, along with measuring total testosterone, serum estrogen level should be taken. High serum estrogen may produce the symptoms of reduced testosterone. If the serum estrogen level is high, the patient is given medication that turns off the estrogen production.
The Beginning of Andropause Starting at the age of 30, men experience a drop in testosterone by about 10% every decade, while amounts of the hormone that are still being manufactured may not be as effective because of increased production of another hormone called SBHG. For some men, this decrease in testosterone results in a condition called Andropause, which has a range of symptoms, including:
â¢ low sex drive â¢ difficulties getting erections or erections that are not as strong as usual â¢ lack of energy â¢ depression â¢ irritability and mood swings â¢ loss of strength or muscle mass â¢ increased body fat â¢ hot flashes
As many as 50% of all men may have low levers of testosterone.
The following is a variety of causes of low testosterone (hypogonadism):
â¢ chronic/systemic illness â¢ surgery â¢ chemotherapy â¢ infections â¢ premature aging â¢ testicular trauma â¢ stress â¢ Kleinfelter's syndrome â¢ autoimmune damage â¢ tobacco and alcohol â¢ sleep apnea â¢ excessive heat â¢ obesity â¢ hypercortisolism â¢ medications â¢ hyperthyroidism â¢ malnutrition
Subtle clinical signs of hypogonadism may include slight gynecomastia (enlarged, male breasts) and soft, small testes. However, researchers have noted that "the findings of physical examination in men with adult-onset hypogonadism are often normal.â
Secondary hypogonadism can develop as a result of hypothalamic or pituitary disease, obesity, hypothyroidism or other causes. Some conditions, such as hypercortisolemia, AIDS and severe systemic illnesses, can trigger hypogonadism through a combination of both primary and secondary mechanisms.
One cause was omitted from the list above, and that is diabetes. About one third of men with type 2 diabetes show low levels of testosterone, and this is seems to be related to abnormal function of the pituitary gland -- the master regulator of hormone production.
Although lower total testosterone levels have been reported in type 2 diabetics, the underlying cause has not been known.
Testosterone helps men reduce body fat and improves the way their bodies handle insulin. So low testosterone levels may have serious consequences for men with diabetes.
Testosterone and Depression There is increasing evidence of an association between testosterone levels and male depression. Two epidemiological studies examined this relationship, with inconclusive results. Observational studies comparing the mean testosterone levels of groups of depressed men with those of non-depressed controls have also yielded discrepant findings. In both types of studies diurnal, seasonal situational and age-related variability in testosterone secretion may have contributed to the inconsistent results.
Leading experts in the field of brain research have observed that "sex steroids exert profound effects on mood and mental state." Many studies have established a direct relationship between decreased testosterone levels and negative mood factors such as depression, anger, confusion, anxiety, and fatigue. Current research has found that testosterone replacement used to restore androgen balance in hypogonadal men improved many emotional parameters, including friendliness, energy levels, and sense of well-being. Significantly, these benefits were maintained over the course of a six-month period of therapy, precluding the possibility of a short-term placebo effect.
Men who have low testosterone levels are more likely to suffer depression, says an article in the February issue of the Archives of General Psychiatry. Researchers examined the clinical records of 278 men, 45 years or older. Over a two-year period, 21.7 percent of the men with testosterone deficiency (hypogonadism) were diagnosed with depression, compared with 7.1 percent of men with normal testosterone levels. When they adjusted for age, alcohol use and other factors, the researchers concluded that men with hypogonadism were 4.2 times more likely to be diagnosed with depression. "Hypgonadal men showed an increased incidence of depressive illness and a shorter time to diagnosis of depression. Further prospective studies are needed to confirm these preliminary findings and to clarify the role of testosterone in the treatment of depressive illness in older men," the study authors write.
But there's no reason for this condition to get so many men down. Doctors can easily diagnose low testosterone with a simple blood, urine or saliva test. If levels come back low, further testing, including more blood tests, taking a sample of tissue from the testicles (called a biopsy), semen analysis, or brain imaging may be required. Once low testosterone is diagnosed, there are a number of different treatment options.
It's normal for men to lose testosterone gradually, beginning in their 20s. By age 75, half a man's testosterone is gone. Some menâs testosterone levels even switch off prematurely. "The real issue is that if they get into their 60s and 70s and it falls even below that, based upon where they started, or if they see a more accelerated drop, they may be at risk for the problems associated with low testosterone," said Dr. Laurence Levine, a urologist at Rush Presbyterian Hospital.
The clinical description is called hypogonadism. Others call it male menopause or irritable male syndrome. Symptoms can include fatigue, depression, weight gain, loss of energy, and less sex drive.
Loss of testosterone, which happens normally as men age, may also be the root of memory loss. Previous studies have shown memory loss to be common in men with prostate cancer who have had treatment with testosterone deprivation therapy. The therapy involves reducing the body's production of testosterone and is a common treatment for prostate cancer. However, it wipes out most of the male hormones in the body. Receptors for testosterone are located in the brain's memory centers.
Testosterone and Rheumatoid Arthritis There does seem to be a link between low testosterone and rheumatoid arthritis (RA), but it is not well documented or researched. It appears that some men with RA do have lower levels of testosterone, but why remains to be seen. There is a proven link however, between testosterone and osteoporosis in males.
The male sex hormone testosterone exerts a powerful, far-ranging influence over emotional well-being, sexual function, muscle mass and strength, energy, cardiovascular health, bone integrity, and cognitive ability throughout a man's entire life.
This profile also provides clear insight into testosterone's synergistic impact on The most common symptoms of testosterone deficiency in men (e.g., loss of libido, sexual dysfunction, fatigue, loss of stamina, depressed mood) are vague and not specific for hypogonadism. Furthermore, men as a group interact with the healthcare system far less often than women, and when they do visit the physician's office, they often do not volunteer such complaints unless directly questioned about them. Physicians can minimize the chance of missing these complaints by routinely asking about libido, sexual function, and stamina in their systems assessment. An alternative is to use a simple questionnaire that patients can fill out in the waiting room.
Patients with normal or slightly low levels of testosterone most likely will derive no benefit from replacement therapy and as such it is not recommended.
Testosterone therapy can be administered in several ways, such as gels, injections, patches, injections and implants. Testosterone replacement has also been linked to improvement in men's mental functioning, night sweats, bone density and muscle mass.
Transdermal Delivery: Gels, Creams, Patches, and Pellets Human skin is able to absorb hormones into the bloodstream rather effectively. Controlled transdermal delivery of testosterone, at a contstant rate is possible, maintaining a steady blood level. Injections can cause very high and very low levels. About 50% of men who participated in clinical trials had a skin reaction to the patch, ranging from mild to blisters. It was found that applying a 0.1% triamcinolone acetonide cream before applying the patch eliminated most skin reactions.
Because scrotal skin is at least 5 times more permeable to testosterone than are other skin sites, the first available testosterone transdermal delivery system (Testoderm; AlzaPharmaceuticals, Palo Alto, Calif) was designed as a scrotal patch. Patients using the scrotal testosterone system have reported substantially improved sexual function, including the achievement of potency, and an improvement in sense of well-being, mood, and energy.
Testosterone gel may increase muscle mass in men, but it is not without potential side effects. Testosterone may lower HDL, known as the âGood Cholesterolâ, and some studies show it may cause liver problems in some men. Although testosterone has not been shown to cause prostate cancer, it can accelerate cancer growth in men that may have unknown prostate cancer.
Nonscrotal transdermal testosterone patches (Androderm, Testoderm TTS) are applied daily and are available in a 2.5-mg (Androderm) and a 5-mg (Androderm and Testoderm TTS) dose. Blood testosterone levels rise to peak values within 4 to 6 hours after application, then decrease slightly to remain within the physiologic range over the next 18 to 20 hours. Applying a patch after showering at night can reproduce diurnal testosterone levels similar to those seen in younger men, in whom morning values are somewhat higher than evening ones. The most common side effect reported is skin irritation. Its frequency seems to increase with age in men over age 50. It often can be prevented or reduced by rubbing triamcinolone cream (Aristocort, Atolone, Kenacort) into the skin before application of the patch.
AndroGel is a clear gel that is rubbed into the shoulders, upper arms or abdomen every day to maintain more even levels of testosterone in the body. It's available only by prescription, and men who take it must be evaluated and monitored by a doctor. AndroGel has caught the attention of men like Poltz because it is easier to use than previous testosterone medications. Until AndroGel hit the market, men needing a testosterone boost had to givethemselves injections or wear a patch on their skin. Injections can't mimic the body's fine control of the hormone, so men often experience emotional and physical ups and downs, including irritability right after the injection and fatigue as it wears off. The patches maintain testosterone at a more even level but can cause skin irritation and may fall off in hot weather. For years, doctors have used testosterone as a medical treatment for some men who have abnormally low levels of the hormone because of the aging process, chronic disease or exposure to alcohol or chemicals. Symptoms of low testosterone include fatigue, decreased sex drive, depression and low energy. Between 4 million to 5 million men have this medical condition, according to Unimed Pharmaceuticals, the company that makes AndroGel. Some experts say that about 25 percent of men go through andropause, the male version of menopause, in which levels of testosterone drop significantly with age. However, in most men, testosterone levels don't change much with age.
Scrotal patch (Testoderm). Thin scrotal skin is much more permeable to testosterone absorption than other skin sites. You apply this patch in the morning and remove it before bathing or sexual intercourse. Itching and skin irritation can occur, but they're usually mild and diminish with continued use. Nonscrotal patch (Androderm). This patch is applied each night to your back, abdomen, upper arm or thigh. The site of the application is rotated to maintain 7-day intervals between applications to the same site. Up to 50 percent of men experience some skin reaction to this product, with approximately 7 percent having a severe reaction.
You rub testosterone gel (AndroGel, Testim) into your skin on your lower abdomen, upper arm or shoulder. As the gel dries, your body absorbs testosterone through your skin. Avoid showering or bathing for several hours after an application to ensure adequate absorption. A potential side effect of the gel is the possibility of transferring the medication to your partner. You can avoid this by waiting approximately 5 hours after an application or covering the area before having skin-to-skin contact.
Testosterone Injections In men 20-50 years of age, an intramuscular injection of 200 to 300 mg testosterone enanthate is generally sufficient to produce serum testosterone levels that are supranormal initially and fall into the normal ranges over the next 14 days. Fluctuations in testosterone levels may yield variations in libido, sexual function, energy, and mood. Some patients may be inconvenienced by the need for frequent testosterone injections.11 Increasing the dose to 300 to 400 mg may allow for maintenance of eugonadal levels of serum testosterone for up to three weeks, but higher doses will not lengthen the eugonadal period.
Testosterone injections should NOT be used in the following circumstances:
â¢ Breast cancer in men â¢ Breastfeeding â¢ Cancer of the prostate â¢ Pregnancy
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately. Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Possible Side Effects of Testosterone Injections:
â¢ Persistent painful erection of the penis (priapism) â¢ Reduced volume of ejaculation â¢ Premature closure of the ends of bones in prepubescent males
causing stunted growth â¢ Decreased sperm count (oligospermia) â¢ Hoarse voice â¢ Sodium and water retention â¢ Increased frequency of erections in prepubescent boys â¢ Premature sexual development in prepubescent boys â¢ Enlargement of the penis in prepubescent boys
Oral Testosterone Although testosterone supplements are manufactured in capsule or pill form, they are not generally recommended for use in the United States. They are quickly broken down by the liver and do not achieve high enough blood levels to be useful. They also may cause adverse changes in blood lipids (fats) and liver damage. [AACE Clinical Practice Guidelines]
Cholestatic hepatitis and jaundice may occur at relatively low doses of 17-alkylated androgens.
Pellet Implants Pellets are a newer, testosterone delivery system.
The pellet is loaded in the pellet inserter and placed into the buttock once every 2-5 months. The pellets slowly release the hormone, usually preventing a 'crash' in hormones until the end of treatment. Most insurance companies, including Blue Cross, reimburse the placement of pellets. The pellets may or may not be reimbursable by individual policies. Medicare does not cover pellets.
Many years ago, the Food and Drug Administration approved the use of testosterone pellets for male hormone deficiencies. They are manufactured in our office by a compounding pharmacist. We place 6-8 testosterone pellets under the skin. These pellets dissolve slowly over a period of approximately three to four months. This provides a normal and very stable serum testosterone level. I feel that the addition of androgens in this form causes less lowering of HDL cholesterol, as this does not pass through the liver
Side Effects of Testosterone Therapy Androgen therapy does lead to recovery of a normal prostate size (the prostate shrinks when testosterone levels are low). It does not affect prostate specific antigen (PSA) levels. Androgen therapy is not thought to increase the risk of prostate cancer above that of men with naturally higher testosterone levels of the same age. However, the safety of androgen therapy on the cardiovascular system, prostate and mental functioning still needs to be properly studied. Further well conducted investigations into whether androgen therapy benefits bone and muscle are also needed.
Androgen therapy is believed to be a risk factor for heart disease but the existing studies are inconclusive. In fact, low testosterone levels have been recorded prior to heart attacks which may indicate that hormone therapy could help protect against cardiovascular disease.
The use of androgens should also be used with caution in older men who may have undiagnosed prostate cancer. Sleep apnea is also an occasional risk factor with androgen therapy.
With any testosterone delivery system, prolonged use may cause liver damage, breast enlargement, or increase the risk of prostate enlargement. Geriatric patients who could be at risk of prostate cancer should be evaluated prior to initiation of treatment. In addition, fluid accumulation may be a serious complication in patients with preexisting heart, kidney or liver disease, with or without heart failure. Men with breast cancer or known or suspected prostate cancer should not receive testosterone therapy. The patch, gel and injections are not indicated for use in women and should not be used in women. Testosterone may cause fetal harm.
Patients taking testosterone should be instructed to report any of the following to their physician:
â¢ Too frequent or persistent erections â¢ Any nausea, vomiting, changes in skin color, or ankle swelling â¢ Breathing disturbances, including those associated with sleep.
To learn more about Andropause and hormone replacement therapy, see http://www.hdmedspaclinic.com