Is andropause real, or is it just a mid-life crisis that happens when men reach a turning point in their lives? Berita Menopos speaks to Assoc Prof Dr Shaiful Bahari Ismail, Deputy Deacon at University Sains Malaysia, for the facts.

What is andropause?
Firstly, andropause is not an accurate term. It was created to match the term ‘menopause’ in women, because the truth is that men ‘never pause’, in the sense that they never lose their reproductive ability.

Physiologically, men differ from women. In women, menopause signifies the end of their reproductive life. When the ovarian follicles stop producing estrogen, the estrogen will come from other sources such as fat. For men, reproductive ability lasts throughout their lives, but due to reasons such as genetics, medical illnesses, medications and age, their testosterone levels will be reduced, whether with or without symptoms.

That’s why the term “androgen deficiency” is a more appropriate term. Testosterone usually reduces gradually after the third decade of life.
 

Are there other names for andropause?
It is also known as ‘Partial endocrine deficiency in aging male’ or PEDAM. The medical term is ‘late onset hypogonadism’, which is used to indicate a low level of androgen or testosterone levels. Is andropause common? Androgen deficiency in aging men is common. In general, it affects 1 in 200 men under 60 years old. In Malaysia, it is estimated to get increasingly common as we are a fast-developing nation with a more and more elderly population above 60. There are as yet no statistics on the prevalence of androgen deficiency in Malaysia.
 

What are the symptoms?
It is important to note that the symptoms may be subtle and its diagnosis overlooked unless
it is actively being sought out. A patient may complain of specific or non-specific symptoms
such as:

• Mood changes (low mood, irritability)
• Poor concentration
• Low energy (lethargy)
• Hot flushes and sweats
• Decreased libido
• Reduced beard or body hair growth
• Low semen volume
• Gynaecomastia (appearance of breast bud)
• Reduced muscle strength
• Fractures (osteoporosis)
• Erectile dysfunction

At what age do the symptoms start appearing?
Usually men will start experiencing the symptoms after forty. The problem is that this is also the time when many men are at crossroads, whether in their personal lives or careers. Many will start questioning if they are doing the right thing and whether they should continue with what they are doing or opt for a change.

Just when they need the focus and energy to face a brighter future in the next half of their lives, their bodies start acting up. Feeling tired, depressed, forgetful and absent-minded can have a drastic impact upon a man’s life when it happens at such a critical phase.

 
How is diagnosis made?
The doctor can make a diagnosis based on symptoms, which indicates reduction of testosterone levels in the morning. The most common reason that brings men to doctors is
erectile dysfunction.

Rather than just requesting for Viagra, men can ask for testosterone tests instead, such as the Bio-T test, Total Testosterone Level, Free Testosterone Level and Free Androgen Index. Costing between RM300 to RM500, these tests provide accurate benchmarks for your doctor in his diagnosis.
 

How important is it to treat androgen deficiency?
The average lifespan of a man is around 70+ in the twenty-first century. If a man starts going
through androgen deficiency at the age of 40, he could be suffering for the next 30 years of his life. It will affect every aspect of his life, including his self-esteem, confidence, family life, productivity levels, even social life and career advancements.

The effects can be far-reaching. Recent studies also show that low testosterone levels are linked to increased cardiovascular risks, with high mortality and morbidity.

It is vital that treatment is individualized. Treatment is important because it will improve the overall quality of life including sexual wellbeing.

 
What are the treatments available?
Before starting on medications, patients need to understand that a wholesome approach involving weight reduction, proper exercise and healthy diet can improve not only testosterone levels but also general wellbeing. However, this takes time to show effect, and most men are not patient enough to wait especially when the symptoms cause distress.

Treatment includes medications such as oral capsules of Andriol Testocaps (taken daily) and Testosterone Enanthate injections (four times a year). The cost depends on where you are treated and the type of medication you are on and whether short or long acting. In order for the oral medications to be more effective, they must be taken with food.

 
Do the medications cause increased violence, weight gain or cancer?
Well-established brands of testosterone replacement therapy (TRT) such as those previously mentioned have been used around the world for the past two decades and have a good safety profile so far. Violence and weight gain happen when there is an abuse of anabolic steroids, which is different from TRT.

TRT returns testosterone levels to a normal range so that patients can have a better quality of life and avoid critical illnesses like diabetes, heart disease and osteoporosis. Over the long run, this may prove to be cost-effective as it increases productivity and energy levels and lowers healthcare costs such as medications for related diseases.

 
Is it suitable for me?
You certainly need to check with your doctor. TRT is not suitable for men with certain medical conditions such as prostate enlargement, prostate cancer, altered cholesterol fractions, recent heart problems, stroke, high haemoglobin levels, bladder outlet obstruction, liver dysfunction and breast cancer.

 
Does it help to share worries about androgen deficiency?
Definitely. Sharing the problem allows men to see that they are not alone. One major symptom of low testosterone level is the lack of libido or sexual arousal, with or without erectile dysfunction. Many men discuss only this aspect of their problem and usually this is what brings them in for treatment. The effect of testosterone deficiency on libido and erectile dysfunction can be tremendous.