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AndropauseWith increasing awareness, men are seeing their doctors with complaints such as excessive fatigue, depression , lost of interest in sex etc ... all common symptoms of a drop in testosterone levels.  This is also sometimes referred to as the male menopause, or Andropause.

Whilst there are certainly similarities, there are, however, some very important differences between andropause and female menopause .  Firstly, unlike menopause, andropause does not automatically occur in all men when they reach a certain age.   Secondly, unlike menopause, andropause is not associated with infertility, although it is usually associated with decreased fertility.  And thirdly, andropause occurs gradually over several years as opposed to menopause which develops over a relatively short period of time.

What Is Testosterone?

Testosterone is a hormone primarily produced by the testes.  In men, testosterone plays a key role in the development of male reproductive tissues such as the testis and prostate as well as promoting secondary sexual characteristics such as increased muscle, bone mass, and the growth of body hair.  In addition, testosterone is essential for health and well-being as well as the prevention of osteoporosis .  It is the force behind a man's sex drive.

With advancing age, some men may begin to experience a gradual decline in testosterone levels.  With a drop in levels, there may be the accompanying symptoms such as:

• Poor libido (low sexual desire)
• Fatigue
• Muscle loss/atrophy
Erectile dysfunction , subfertility
• Increased abdominal fat
• Glucose intolerance (early diabetes )
High cholesterol/lipids
Poor sleep
• Difficulty concentrating
• Memory loss
• Psychological and relationship problems
• Gynecomastia (enlargement of breasts in a male)
• Decrease in growth, or loss of beard and body hair
• Irritability
• Shrinking of the testes

As one would notice from the list above, low testosterone produces very non-specific symptoms, which are mirrored by other common medical problems.  For a long while, doctors were not attributing these symptoms to low testosterone levels, but to hypertension, diabetes, depression and so on.  But with increasing awareness, it may well be that testosterone is at the root of many problems.

Doctors will want to rule out other possible explanations for symptoms before blaming them on low testosterone levels. They will also want to do a blood test to determine a man's testosterone level. 

What Are The Causes Of Low Testosterone?

Andropause is only one of the many possible causes of low testosterone levels.  Low testosterone levels may in fact, be caused by any disruption to the normal hormonal axis.  A problem at the level hypothalamus or pituitary may lead to a reduction of stimulatory hormones which in turn causes the testes to produce insufficient amounts of testosterone.   Another possibility is that the testes themselves, may be unable to produce sufficient amounts of testosterone.

When the problem lies in the organs that produce testosterone, i.e. the testes and ovaries (yes, the ovaries also do produce small amounts of testosterone), it is called "Primary Hypogonadism". ("gonads" are the medical term for the sex organs)

When the problem is related to the pituitary and its ability to regulate testosterone, it is called "Secondary Hypogonadism", and if the problem is at the level of the hypothalamus, it is termed "Tertiary Hypogonadism".

Some common causes of Primary Hypogonadism:

Undescended testicles: In this condition, the testes fail to migrate from the abdomen into the scrotum during fetal development, and as a result of the warmer temperatures within the abdominal cavity, the testes become damaged and are unable to produce adequate amounts of testosterone.

Injury to the testes: If the testes are injured, either physically, or due to disease (eg. orchitis in mumps), they may not be able to produce adequate testosterone.

Cancer therapy: Chemotherapy and radiation therapy can damage the cells in the testes responsible for testosterone production.

Andropause: Testosterone levels decrease with aging.

Causes of Secondary and Tertiary Hypogonadism include:

• Tumours in the brain

• Compromised blood flow to the pituitary or hypothalamus

• Inflammation (eg. tuberculosis) and infections (eg. HIV, AIDS)

It is interesting to note that obesity may also be a cause of low testosterone levels.  Testosterone is naturally converted to estrogen in the body, occurring primarily in fat cells.  Hence, in obesity, where there is an increase in the amount of fat cells, testosterone levels may fall due to excessive conversion to estrogen.

How Is It Diagnosed?

Your doctor will ask you about your symptoms, and proceed to conduct a physical examination, before ordering blood tests to determine your testosterone levels.  The level of testosterone varies depending upon the time of day, and most often, early morning testosterone levels are measured.

Based upon your doctor's suspicions, further tests may be done to determine whether it is a case of primary, secondary or tertiary hypogonadism.

How Is It Treated?

Low testosterone levels may be treated by testosterone replacement.  Testosterone replacement therapy can be in various forms, eg. as an injection, patch or gel. Each of the treatments has its risks and benefits which will need to be discussed with your doctor.

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The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.