The Impact of Andropause on Men - Essay Example

The Impact of Andropause on Men Andropause, also known in various terms like manopause, late onset of hypogonadism,androgen decline in the aging male (ADAM), partial androgen deficiency in the aging male (PADAM), or aging-associated androgen deficiency (AAAD), is a condition caused by hormonal deficiency secondary to gonadal failure (Brawer 9; Taher 84; Wespes and Schulman 93). The term male menopause is incorrect since the production of sperm never ceases or interrupted nor there is any loss of virilization in men (Taher 84). Andropause is a critical issue concerning men but does not often receive enough attention compared to the widespread campaign of menopausal awareness with women and the numerous complex researches conducted about it. In the United States, about 5 million men suffer from early case of andropause while one in every 200 men under the age of 60 in Australia experiences the said condition. Because of the limited available material on the symptoms, diagnosis and treatment of andropause, further studies and stronger information dissemination are needed to help confused individuals understand and overcome their situation (Wespes and Schulman 93). On this paper, the important concerns on the subject of andropause are to be addressed: What is andropause and what are its symptoms? How does it impact the affected individuals? Is this condition needs medication and what are the available treatments? Based on the definition by Morales and Lunenfeld, Brawer (9) described andropause as a biochemical syndrome associated with advancing age and characterized by a deficiency in serum androgen levels with or without a decreased genomic sensitivity to androgens. It may result in significant alterations in the quality of life and adversely affect the function of multiple organ-systems. The progressive reduction in serum testosterone as men ages has been reported on numerous studies over the years. Testosterone or the hormone responsible for facial and body hair patterns, deep voice and muscle mass, gradually decreases after men reach the age of 30. Sperm production also declines during this period causing affected individuals to experience physical and psychological symptoms including low sex drive and erectile dysfunction, lack of energy, loss of body hair, depression and mood changes, decreased bone density resulting to osteoporosis, reduction of lean body mass and muscle mass strength, and escalation of fat around internal organs. Other studies also reveal the association of andropause with Alzheimer’s disease (Brawer 10). In addition, age is a strong factor in the occurrence of this illness. Reports show that men aged 40 to 49 years have a maximum of 5% chance in getting andropause, men aged 50 to 59 has a wide range of 6% to 40% chance, those between 60 and 69 years are likely to have one at 45% probability, while those under 70 to 79 years of age have 70% chance to have it. Ultimately, 90% of men who live over 80 years old suffer from andropause. Consequently, workplace environment may encourage the onset of premature andropause brought by exposure to estrogen through excessive female hormone stimulation particularly in plastics and pharmaceutical factories, workplace near incinerators, and farms that use pesticides (Brawer 9). However, it is essential to contemplate that the symptoms of andropause may affect men in different ways and in varying degrees. Most importantly, not all middle-aged to elderly males experience this stage in their sexual life and if they do, it is in gradual manner unlike the abrupt changes that menopause brings to women. To determine the nature of the symptoms, doctors take blood tests from patients and check for testosterone levels using the analog free testosterone method (Vermeulen 7). The causes of andropause are comprised not only by the decrease in testosterone but with the increase of the sex hormone binding globulin (SHBG) levels as well. SHBG binds some available testosterone available in the blood. As SHBG increases, more testosterone are pulled out of the blood which results to the reduction of bioavailable testosterone or the available amount of testosterone available for use by the body. Despite these observations, one cannot rule out the possibility of other diseases that may cause the symptoms since the age factor in males increases the body's susceptibility to infection and stress. For instance, erectile dysfunction may be an effect of vascular or neurogenic disorders. Other conditions that may influence and modify testosterone levels in diseases and lifestyle include acute critical illness, surgical injury, coronary atherosclerosis, chronic renal failure, chronic renal disease, sleep apnea syndrome, smoking, alcohol intake and improper diet. Therefore, physical examination and thorough diagnosis are critical in identifying possible cause of the problem and its suitable treatment (Wespes and Schulman 93-94). Due to the extent and severity of the changes that andropause inflicts on affected individuals, this illness creates a huge impact on both mental and physical health of men and hence their quality of life. Androgen deficiency does not only affect the physical, psychological and sexual activities of elderly males but with their overall life satisfaction as well. Moreover, culture, social norms, age, and economic standing dictate the level of acceptance of men on the subject. The concept of andopause is regarded as a widely accepted condition in some parts of Europe and in Australia but receives opposition in the United States (Brawer 12). In a study conducted by Taher (86) on the proportion and acceptance of andropause symptoms among elderly men in Indonesia, “the degree of andropause, marriage status, and type of job affect the acceptance of andropause. The more severe the degree of andropause, the more they cannot accept the conditions.” A progressively positive assessment of resources such as partnership, friends, living, leisure time and finances as components of life satisfaction may help patients to accept their condition or even improve a their satisfaction with self. On the other hand, unemployment and low household income make men more exposed to depression, illnesses and low life satisfaction. The concept of andropause and its impact on men gained popular attention upon the publishing of Male Menopause by Jed Diamond. Using a layman’s point view on the disorder, Diamond related the adjustments which men submit to at the hormonal, interpersonal, social, physical, sexual, spiritual and psychological phases. The demonstration of the similarities of the life impacts of andropause in men with menopause on women produced a sympathetic approach to the phenomena that further facilitated a better understanding and easier acceptance from the affected population (Taher 87). Furthermore, the long term and silent effects that come with low testosterone levels such as the risks of osteoporosis and cardiovascular diseases in middle aged men establish the seriousness of male andropause. Testosterone is a key component in maintaining healthy bones in men. Unluckily, the decline of male bone density as a person ages combined with declining testosterone levels intensifies the occurrence of osteoporosis particularly in men over the age of 50. When bone density is too low, a person is likely to endure frequent fractures in hips, wrists, spine and ribs, and associated pain. Meanwhile, low testosterone level is also associated with increased cardiovascular risks factors in men. Research and clinical trials are still limited as regards to this concern, thus further studies are needed for future reference (Vermeulen 9). The debate on whether male andropause is a disease that needs to be diagnosed and treated or just a normal way of life and biological change in men to be left to die down naturally remains strong. Notwithstanding the emphasis to address appropriate diet and exercise, proponents of andropause stress the requirement of effective treatment including hormone replacement therapy and selective androgen receptor modulators to alleviate its effects. According to Brawer (14), testosterone replacement therapy is the most common treatment of andropause. It involves the replacement of the hormone in the blood using different preparations such as skin patches, buccal tablets, gels, oral agents or capsules and injectable formulations. Each preparation offers a different mode of action, ease of usage and cost. Documented positive effects of testosterone replacement includes changes in body composition particularly a decrease in body fat, improvement in muscle strength and increase in lean body mass. An increase in bone density and decrease in bone turnover are observed after patients undergo testosterone therapy. More so, the mood, aspects of cognition and sexual behavior of men treated with testosterone therapy showed signs of improvement. Together with change in lifestyle, testosterone treatment can provide relief from the symptoms of the disease and aid on in the improvement of the quality of life of the patients (Wespes and Schulman 95). Still, adverse effects of androgen substitution are evident. Wespes and Schulman (96) sum up these antagonistic effects as Water retention, development of polycythemia, hepatoxicity, exacerbation of sleep apnea, development of detrimental effects on the cardiovascular system, and exacerbation of pre-existent benign or malignant prostate disease… Water retention could lead to hypertension, peripheral edema, or exacerbation of congestive heart failure. The authors noted the stimulatory effects of androgen on erythropoiesis which triggers hematopoiesis and sleep apnea. Administration of aromatizable androgens may cause gynecomastia in older men, especially to those patients with liver or renal disease. Body fluid and glucose metabolism can be affected by administration of testosterone as well as the addition of the hormone may “produce fluid retention, aggravating hypertension, peripheral edema, and compulsive heart failures. Men treated with testosterone produce a decrease in fasting glucose in blood and a decrease in insulin resistance.” (Wespes and Schulman 96). Lastly, prostate size and prostate-specific antigen (PSA) are also observed to increase as testosterone is substituted since metastatic or local prostate cancer is dependent on androgens to grow fully. Hence, andropause is a significant phenomenon in the male population for which further studies are necessary to be conducted in order to increase awareness about the illness. The potential risks of androgen therapy specifically in older men with certain coexistent medical problems are too great to be ignored. Casey (47) called the use of hormonal therapy in andropause as “primarily a market-driven concept, largely promoted by industry, accepted by a handful of physicians and embraced by some patients who are looking for an antidote to aging.” The indications, benefits and long term safety of patients must be taken into consideration before indulging any treatment method to illnesses. Educating the male population about the nature and symptoms of their condition combined with the campaign of healthy lifestyle and exercise will assist them in dealing with the impact of andropause to men. Summary The definition, symptoms, diagnosis and treatment of the condition of andropause in middle aged to elderly men were presented. After completing the review, the author’s perception with andropause remained unchanged, that its description is parallel with menopause in women. Although not necessarily the same in terms of the extent of virility and sterility, the impact of andropause in men in the psychological, physical, sexual and social aspects are similar with what women experience during their menopausal stage. With the researches and clinical trials observed in this paper, the author had a better understanding with the topic as well as with what the affected individuals are going through during this critical period. Andropause is a condition caused by the decrease of testosterone levels in men above 30 years old as influenced with age and other outside factors. Symptoms of this illness involve changes in the physical, psychological, sexual and social functions of men that can be treated with testosterone substitution. However, adverse effects on increasing androgen in elderly men’s health raise an alarm pertaining to the need of treatment or medications to the andropause. Nevertheless, patient education, positive assessment resources, proper diet and regular exercise can mitigate the effects of the disease and promote acceptance and improved quality of life to the affected population. Works Cited Brawer, Michael K. “Testosterone Replacement in Men with Andropause: An Overview”. Review in Urology. 6.6 (2004): 9-15. Print. Casey, Richard. “The Use of Hormonal Therapy in Andropause: The Con Side.” Canadian Urology Association Journal. 2.1 (2008): 47-48. Print. Taher, Akmal. “Proportion and Acceptance of Andropause Symptoms Among Elderly Men: a Study in Jakarta”. Indonesian Journal of Internal Medicine. 37.2 (2005): 82-86. n.d. Web. 28 Oct. 2012. Vermeulen, A. “Andropause”. Maturitas. 34.1 (2000): 5-15. n.d. Web. 29 Oct. 2012. Wespes, E. and Schulman, C.C. “Male Andropause: Myth, reality, and Treatment.” International Journal of Impotence Research. 14.1 (2002): 93-98. Print. Read More