Andropause 1630471 223800470 2008-07-05T21:41:50Z Jeremy68 1273912 {{POV|date=December 2007}} {{Expert-subject|Medicine|article|category=Pages needing expert attention}} '''Andropause''' (or '''male [[menopause]]'''<ref name="titleMale Menopause">{{cite web |url=http://www.clevelandclinic.org/health/health-info/docs/3000/3001.asp?index=10094 |title=Male Menopause |accessdate=2007-12-17 |format= |work=}}</ref>) 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,<ref>{{MeshName|Andropause}}</ref> which is associated with a decrease in [[Leydig cell]]s.<ref>{{Dorlands|a_36|14179710}}</ref><ref name="pmid16902519">{{cite journal |author=Mahmoud A, Comhaire FH |title=Mechanisms of disease: late-onset hypogonadism |journal=Nat Clin Pract Urol |volume=3 |issue=8 |pages=430–8 |year=2006 |pmid=16902519 |doi=10.1038/ncpuro0560}}</ref> 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 (medicine)|disorder]]. A decline in testosterone level with age is well documented,<ref name="pmid16645432">{{cite journal |author=Mooradian AD, Korenman SG |title=Management of the cardinal features of andropause |journal=Am J Ther |volume=13 |issue=2 |pages=145–60 |year=2006 |pmid=16645432 |doi=10.1097/01.mjt.0000132252.80403.c9 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00045391-200603000-00011}}</ref> 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<REF>Heller, C.G., Myers, G.B., “The Male climacteric: Its symptomatology, diagnosis and treatment.” ''JAMA'' 1944; 126:472-77.</REF> identified symptoms of what they labeled the "male [[Climacteric (biology)|climacteric]]" including loss of [[libido]] and potency, nervousness, [[depression (mood)|depression]], impaired memory, the inability to concentrate, [[fatigue (medical)|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]].<ref name="pmid17917157">{{cite journal |author=Fuller SJ, Tan RS, Martins RN |title=Androgens in the etiology of Alzheimer's disease in aging men and possible therapeutic interventions |journal=J. Alzheimers Dis. |volume=12 |issue=2 |pages=129–42 |year=2007 |pmid=17917157 |doi= |url=http://iospress.metapress.com/openurl.asp?genre=article&issn=1387-2877&volume=12&issue=2&spage=129}}</ref> In one study, 98.0% of [[primary care physicians]] believed that andropause and [[osteoporosis]] risk were related.<ref name="pmid17178557">{{cite journal |author=Pommerville PJ, Zakus P |title=Andropause: knowledge and awareness among primary care physicians in Victoria, BC, Canada |journal=Aging Male |volume=9 |issue=4 |pages=215–20 |year=2006 |pmid=17178557 |doi=10.1080/13685530601040661 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/13685530601040661&magic=pubmed |unused_data=||1B69BA326FFE69C3F0A8F227DF8201D0}}</ref> The term "symptomatic late onset [[hypogonadism]]" (or "SLOH") is sometimes considered to refer to the same condition as the word "andropause".<ref name="titleColumbia Presbyterian - Department of Urology">{{cite web |url=http://cumc.columbia.edu/dept/urology/What_is_hypogonadism_Intro.html |title=Columbia Presbyterian - Department of Urology |accessdate=2007-12-17 |format= |work=}}</ref> <ref name="titleThere's help for grumpy old men">{{cite web |url=http://www.medicalnewstoday.com/articles/24551.php |title=There's help for "grumpy old men", but they're reluctant to admit to problem, says Queen's urologist |accessdate=2007-12-17 |format= |work=}}</ref> 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 [[Asymptote|asymptotic]]<ref name="pmid15799125">{{cite journal |author=Morales A |title=Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies |journal=Aging Male |volume=7 |issue=4 |pages=297–303 |year=2004 |pmid=15799125 |doi=10.1080/13685530400016664}}</ref> (in contrast to the more abrupt change associated with menopause {{Fact|date=February 2008}}.) The "D" is sometimes given as "decline" instead of "deficiency".<ref name="titleColumbia Presbyterian - Department of Urology">{{cite web |url=http://cumc.columbia.edu/dept/urology/What_is_hypogonadism_Intro.html |title=Columbia Presbyterian - Department of Urology |accessdate=2007-12-17 |format= |work=}}</ref> In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.<ref name="pmid15854780">{{cite journal |author=Tancredi A, Reginster JY, Luyckx F, Legros JJ |title=No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause' |journal=Psychoneuroendocrinology |volume=30 |issue=7 |pages=638–46 |year=2005 |pmid=15854780 |doi=10.1016/j.psyneuen.2005.02.002 |url=http://linkinghub.elsevier.com/retrieve/pii/S0306-4530(05)00041-7}}</ref> ==Andropause as a "disorder"== ===Proponents=== Its proponents claim that it is a biological change experienced by [[man|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.<ref name="isbn1-57071-397-9">{{cite book |author=Diamond, Jed |title=Male Menopause |publisher=Sourcebooks |location=Naperville, Ill |year=1998 |pages= |isbn=1-57071-397-9 |oclc= |doi=}}</ref> 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<ref>[http://www.timesonline.co.uk/tol/news/world/asia/article2302545.ece "Father, 90, shows off new baby" - timesonline.co.uk], retrieved 9/08/07</ref>). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.<ref name="isbn0-471-40262-1">{{cite book |author=Cetel, Nancy |title=Double Menopause: What to Do When Both You and Your Mate Have Hormonal Changes Together |publisher=Wiley |location=New York |year=2002 |pages= |isbn=0-471-40262-1 |oclc= |doi=}}</ref><ref name="isbn1-57071-433-9">{{cite book |author=Diamond, Jed |title=Surviving Male Menopause. A Guide for Women and Men |publisher=Sourcebooks |location=Naperville, Ill |year=2000 |pages= |isbn=1-57071-433-9 |oclc= |doi=}}</ref><ref name="isbn0-9707061-0-3">{{cite book |author=Tan, Robert S. |title=The andropause mystery: unraveling truths about the male menopause |publisher=AMRED Pub |location=Houston, Tex |year=2001 |pages= |isbn=0-9707061-0-3 |oclc= |doi=}}</ref> The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.<ref name="isbn1-84214-032-9">{{cite book |author=Carruthers, Malcolm |title=Androgen Deficiency in the Aging Male |publisher=Taylor & Francis Group |location=London |year=2004 |pages= |isbn=1-84214-032-9 |oclc= |doi=}}</ref> ===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.<ref name="isbn0-9707061-0-3">{{cite book |author=Tan, Robert S. |title=The andropause mystery: unraveling truths about the male menopause |publisher=AMRED Pub |location=Houston, Tex |year=2001 |pages= |isbn=0-9707061-0-3 |oclc= |doi=}}</ref> Opposition is not limited to the US.<ref name="pmid12416079">{{cite journal |author=Juul A, Skakkebaek NE |title=[Testosterone treatment of elderly men. The so called andropause doesn't exist] |language=Danish |journal=Ugeskr. Laeg. |volume=164 |issue=42 |pages=4941–2 |year=2002 |pmid=12416079 |doi=}}</ref> 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.<ref name="pmid18033631">{{cite journal |author=Morley JE |title=The diagnosis of late life hypogonadism |journal=Aging Male |volume=10 |issue=4 |pages=217–20 |year=2007 |pmid=18033631 |doi=10.1080/13685530701695463 |url=http://www.informaworld.com/openurl?genre=article&doi=10.1080/13685530701695463&magic=pubmed |unused_data=||1B69BA326FFE69C3F0A8F227DF8201D0}}</ref> * Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise. <REF>Mintz, A.P., Dotson, A. & Mukai, J. Hormone modulation, low glycemic nutrition, and exercise instruction: Effects on disease risk and quality of life. Journal of Anti-Aging Medicine, 4, 357-371, 2001. [http://www.liebertonline.com/doi/abs/10.1089/10945450152850678?cookieSet=1&journalCode=rej.1 link]</REF> * 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.<ref name="isbn1-57954-798-2">{{cite book |author=Diamond, Jed |title=The Irritable Male Syndrome : Managing the Four Key Causes of Depression and Aggression |publisher=Rodale Books |location=Emmaus, Pa |year=2004 |pages= |isbn=1-57954-798-2 |oclc= |doi=}}</ref> ==Treatment== Several intervention strategies have been found to be effective.<ref name="isbn1-57071-397-9">{{cite book |author=Diamond, Jed |title=Male Menopause |publisher=Sourcebooks |location=Naperville, Ill |year=1997 |pages= |isbn=1-57071-397-9 |oclc= |doi=}}</ref> <ref name="isbn1-57071-433-9">{{cite book |author=Diamond, Jed |title=Surviving Male Menopause. A Guide for Women and Men |publisher=Sourcebooks |location=Naperville, Ill |year=2000 |pages= |isbn=1-57071-433-9 |oclc= |doi=}}</ref> <ref name="isbn1-57954-798-2">{{cite book |author=Diamond, Jed |title=The Irritable Male Syndrome : Managing the Four Key Causes of Depression and Aggression |publisher=Rodale Books |location=Emmaus, Pa |year=2004 |pages= |isbn=1-57954-798-2 |oclc= |doi=}}</ref> <ref name="isbn1-84214-032-9">{{cite book |author= |title=Androgen Deficiency in the Aging Male |publisher=Taylor & Francis Group |location=London |year=2004 |pages= |isbn=1-84214-032-9 |oclc= |doi=}}</ref> These include: *[[Hormone replacement therapy]]<ref name="isbn1-58890-296-X">{{cite book |author=Tan, Robert S. |title=Aging Men's Health: A Case-Based Approach |publisher=Thieme Medical Publishers |location=New York |year=205 |pages= |isbn=1-58890-296-X |oclc= |doi=}}</ref> *[[Exercise]], [[dietary]] changes, [[stress reduction]] <ref name="isbn1-58890-296-X" /> *[[Couple counseling]], [[career]] refocusing, and [[spiritual]] support{{Fact|date=December 2007}} *[[Chemical dependency]] treatment, [[sexual compulsivity]] treatment{{Fact|date=December 2007}} *Treatment for depression{{Fact|date=December 2007}} *Finding and engaging one’s “calling” in the second half of life{{Fact|date=December 2007}} [[Selective androgen receptor modulator]]s have also been proposed.<ref name="pmid12581627">{{cite journal |author=Tan RS, Pu SJ, Culberson JW |title=Role of androgens in mild cognitive impairment and possible interventions during andropause |journal=Med. Hypotheses |volume=60 |issue=3 |pages=448–52 |year=2003 |pmid=12581627 |doi= 10.1016/S0306-9877(02)00447-4|url=http://linkinghub.elsevier.com/retrieve/pii/S0306987702004474}}</ref> ==References== {{Reflist|2}} ==See also== * [[Irritable Male Syndrome]] == External links == * {{DMOZ|Health/Men%27s_Health/Andropause/}} {{Reproductive physiology}} [[Category:Endocrinology]] [[Category:Menopause]] [[Category:Middle age]] [[de:Klimakterium virile]] [[es:Andropausia]] [[eo:Andropaŭzo]] [[fr:Andropause]] [[it:Andropausa]] [[he:גיל המעבר אצל גברים]] [[pl:Andropauza]] [[pt:Andropausa]] [[sv:Andropausen]] [[vi:Nam mãn]] [[uk:Андропауза]]