andropause
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Introduction
Declining androgen levels in older men.
Etiology
Pathology
- decreased luteinizing hormone (LH)
- in advanced old age luteinizing hormone is increased[6]
- decreased testicular response to LH
- decreased testosterone secretion from Leydig cells of testes (bioavailable testosterone < 70 ng/dL)
- decreased adrenal secretion of DHEA & DHEA-sulfate
- hyporesponsiveness of hypothalamic-pituitary axis to decreased serum testosterone levels
Clinical manifestations
(also see hypogonadism)
- decreased libido
- erectile dysfunction
- sarcopenia
- decreased muscle strength
- decreased bone mineral density
- decreased sexual hair
- increased adipose tissue
- depression
- lack of motivation
Laboratory
- total testosterone* in serum < 300 ng/dL
- the recommended initial screening test for andropause
- fasting in the morning on two separate occasions
- free testosterone < 5 ng/dL
- more expensive & less available than total testosterone
- useful when total testosterone is marginal & patient has condition(s) that effect SHBP[8]
- aging is associated with increased serum sex hormone binding globulin
- decreased luteinizing hormone in serum
- in advanced old age luteinizing hormone in serum is increased[6]
- complete blood count (CBC) may show anemia
- serum LH & serum FSH to distinguish primary from secondary androgen insufficiency
- serum prolactin to assess pituitary function
* also see hypgonadism for testosterone assessment
Complications
- low serum testosterone, high serum LH (> 10 IU/L), or very low serum estradiol (< 5.1 pmol/L) associated with increased all-cause mortality[5]
- low serum SHBG associated with diminished risk of mortality[5]
- U-shaped relationship of serum dihydrotestosterone & mortality[5]
Differential diagnosis
- a marker of poor health
Management
- testosterone (also see testosterone replacement therapy)
- re-evaluate 3, 6 & 12 months after initiation of therapy, thereafter at least annually[2]
- monitor hematocrit, serum PSA
More general terms
Additional terms
- erectile dysfunction (ED)
- testosterone (Delatestryl Testopel, Striant, Intrinsa, Xyosted)
- testosterone replacement therapy; androgen therapy
References
- ↑ Solomon DH, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 Kazi M et al, Considerations for the diagnosis and treatment of testosterone deficiency in elderly men. Am J Med 2007, 120:835 PMID: https://pubmed.ncbi.nlm.nih.gov/17904450
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ 4.0 4.1 Nguyen CP, Hirsch MS, Moeny D et al Perspective. Testosterone and "Age-Related Hypogonadism" - FDA Concerns. N Engl J Med 2015; 373:689-691. August 20, 2015 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/26287846 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMp1506632
- ↑ 5.0 5.1 5.2 5.3 Yeap BB, Marriot RJ, Dwivedi G et al Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses. Ann Intern Med 2024. May 14. PMID: https://pubmed.ncbi.nlm.nih.gov/38739921 Review. https://www.acpjournals.org/doi/10.7326/M23-2781
- ↑ 6.0 6.1 6.2 Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ McBride JA, Carson CC 3rd, Coward RM. Testosterone deficiency in the aging male. Ther Adv Urol. 2016 Feb;8(1):47-60. doi:http://dx.doi.org/ 10.1177/1756287215612961. PMID: https://pubmed.ncbi.nlm.nih.gov/26834840 Free PMC article. Review.
- ↑ 8.0 8.1 Bhasin S, Brito JP, Cunningham GR, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 Mar 17. PMID: https://pubmed.ncbi.nlm.nih.gov/29562364