Andropause: The “Male Menopause”
n 1980, an 18-year veteran po- lice detective in Ontario with a previously spotless record stole approximately $1000.00 worth of items from the evidence room of his department. He persuaded the judge in his case to spare him a prison sentence, claiming that “male menopause” had clouded his judgment. Ever since the term “male
I
menopause” was first coined in 1949, there have been debates about whether men go though a psychological and physiological change that is similar to meno- pause in women. The problem is that menopause literally means “the end of menses,” so it de- scribes the loss of something that men never have. Despite that, men do experience physical changes as they age that, like menopause, are caused by a decrease in hormone production. Unlike meno- pause, this decrease in hormone production is drawn out over most of a man's adult life. This has lead to a series of attempts to find a better term to describe what is happening. Many doctors use the term “andropause” to describe the age-related hormone changes in men. Irritability, fatigue, depression, reduced libido and erection problems are hallmark signs of andropause. Andropause can be taken to mean “the end of male-ness.”
More accurately, it should be thought of as a reduction in the production of hormones called “androgens” that produce male sexual characteristics. The chief androgen in humans is testoster- one. Testosterone is the hormone that makes men, men. Testosterone production varies throughout a man’s life.
Before birth, testosterone and other androgens drive the dif- ferentiation of the embryo into a male baby. In early infancy, testosterone levels rise and then retreat for reasons that are not well-understood. Through childhood, testosterone is very low, but then it increases greatly in puberty. Starting at about age 30, testosterone production drops approximately 1% to 3% a year and this decrease continues until the end of life. What principally distinguishes menopause from andro-
pause, therefore, is the time scale and rate at which sex hor- mone production changes. In women, menopause is a distinct life stage lasting 1-10 years. Once menopause is complete, pro- duction of sex hormones remains at a steady lower level until the end of life. By contrast, men normally experience no such abrupt change in sex hormone production and the decline of
production continues throughout old age.
Another way menopause is
different from andropause is in how it changes fertility. Although there are many women who mis- take the appearance of menopause symptoms for the end of fertility, earlier at some point in the peri- menopause transition the ovaries will stop producing new eggs and she will no longer be able to be- come pregnant. In men, however, the production of sperm can con- tinue until very late in life at levels high enough to cause pregnancy. Despite these differences in
timing and fertility, however, there is a real biological change hap- pening in men as they age. While there is not yet any officially rec- ognized diagnosis of andropause, researchers have been defining a
wide range of ways the reduction in testosterone affects men, us- ing terms like Symptomatic Late-Onset Hypogonadism (SLOH) and Androgen Deficiency in the Aging Male (ADAM). These terms may be more accurate ways of describing testosterone deficiency that has dropped enough to produce recognizable symptoms. Testosterone production varies not only with age but also
daily and in response to stress. Peak production occurs in the morning decreasing through the day to a valley in the evening. Testosterone is produced by the testicles and adrenal glands and released into the blood stream where most is bound to proteins called sex-hormone binding globulin (SHBG), and other proteins such as albumin. The SHBG-bound portion is very tightly bound making it unavailable for use by the body, leaving approximately 2% “free” testosterone and 23% loosely-bound “bioavailable” testosterone. When it reaches its target, a small portion of testos- terone is converted into a more potent metabolite called dihy- drotestosterone (DHT). Like menopause, testosterone deficiency is an endocrine
condition that causes changes in a man’s metabolism with short and long-term effects in many different organs and systems. The musculoskeletal system shows lower density in the bones and weaker muscles. In the cardiovascular system, testosterone de- ficiency is associated with atherosclerosis, coronary artery dis- ease, and other cardiovascular diseases. In the nervous system, low testosterone shows up as decreased libido, increased rates of depression and cognitive difficulties. It is also linked to erec-
www.naturalnutmeg.com June 2010
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