Harvey S. Bartnof, M.D. Founder and Medical Director at California Longevity and Vitality Medical Institute® San Francisco, California Copyright 2011-All rights reserved

NOTE: The following information about Andropause is meant for education and informational purposes only and is not intended to diagnosis or treat any medical condition, including Andropause. Only a competent, experienced physician would be able to establish the diagnosis and treat appropriately.

What is Andropause?

Andropause refers to a decline in testosterone in men, with a group of symptoms, physical changes on the body, and specific blood tests. Andropause may be associated with other related hormone imbalances, particularly increased estrogen (the main female hormone). The term 'andropause' comes from the Greek prefix 'andro'˜ meaning male or man and the suffix 'pause' meaning cessation or stopping. In Europe, there is a group of physicians and researchers who belong to the European Menopause and Andropause Society (EMAS).

What are Hormones?

Hormones are a group of natural substances in the body that are produced in one location, a gland, and travel throughout the body to help with normal function of the organs and the body. Hormones are essential for optimal health. Lack of specific hormones can be lethal (for example, thyroid hormone). Hormone declines or imbalances are linked with declining health.

Are there other names for Andropause?

Other terms are:

  • ADAM or Androgen Deficiency in the Aging Male (androgen refers to male-like hormones);
  • PADAM or Partial Androgen Deficiency in the Aging Male;
  • Viropause (decline in virility or masculinity);
  • Male Menopause (menopause is decline in female hormones in women); and
  • Male Climacteric 

Is Andropause the same as Hypogonadism in Men?

Hypogonadism in men refers to low testosterone and symptoms that may occur anytime from puberty (teenage years) through an older age. Andropause generally refers to a decline in testosterone and symptoms, after having had a normal testosterone earlier in the man's life. Sometimes, andropause has been referred to as 'Late-Onset Hypogonadism.' Compared to Andropause, men with hypogonadism may be more likely to have low sperm counts and be infertile, meaning unable to father a child. Men with andropause may also have low sperm counts, but not always.

What are the symptoms of Andropause?

There may be only a few or many symptoms, and not all men will have all symptoms. These may include:

  • Lower energy or fatigue;
  • Lower sex drive or libido;
  • Softer erections, 'erectile dysfunction' or loss of morning erections;
  • Breast discomfort or Gynecomastia (enlargement of breasts possibly with a more female appearance); and
  • Hot flushes or night sweats. Other non-specific symptoms may include:
  • Loss of motivation and self-confidence;
  • Feeling sad, depressed or anxious;
  • Poor concentration;
  • Declining memory;
  • Sleep disturbance;
  • Increased need for napping; and
  • Decreased physical strength. 

What are the body changes of Andropause?

There may be several changes on the body, and not all men with Andropause will have all changes. These may include:

  • Increased body weight, especially increased body fat, often around the mid-section or waistline;
  • Decreased muscle mass and strength and eventual frailty;
  • Less armpit hair (may happen very slowly that patients often are unaware);
  • Less pubic hair in the genital area;
  • Decline in bone strength (measured by a scan) and risk of bone fracture and height loss;
  • Increased wrinkling (with very low levels of testosterone);
  • Blood pressure may also be high, although there are many co-factors for high blood pressure; and
  • Others. 

What are the blood changes of Andropause?

There are several changes in Andropause that may be seen on blood tests. The main change is a low or low-end level of testosterone, the main male hormone. Measuring total testosterone is insufficient. Other changes may include (not all men will have all changes):

  • Increase in estrogen (female hormone);
  • Change in DHT (dihydrotestosterone), another male hormone;
  • Abnormal insulin;
  • Other hormone abnormalities;
  • Anemia (low red cell count);
  • Increased glucose (sugar) related to diabetes or pre-diabetes;
  • Possible changes in liver and kidney tests; and
  • Others. 

Are there other abnormal tests that occur with Andropause?

Yes, Andropause may be due to other diseases, so other abnormal tests might be linked with Andropause. For example, abnormal breathing tests or abnormal chest x-rays that are seen with chronic lung disease (emphysema, others) might be a tip-off for possible Andropause. Low bone density (osteopenia, osteoporosis) might be due to Andropause. Other abnormal imaging studies (CT, MRI, x-rays) of the brain might occur with Andropause. Low sperm counts may be due to Andropause. There are other abnormal tests associated with Andropause.

What causes Andropause?

Testosterone levels in men start to decline at age 30 years, due to aging itself. Cells in the testicles make less and less testosterone as men become older. According to the New England Journal of Medicine, approximately 10% men in their 40s have low testosterone; 25% of men in their 50s; 45% of men in their 60s; 70% of men in their 70s; and further increases in older men. Men with the following conditions are more likely to develop or have Andropause:

  • Diabetes;
  • Pre-diabetes;
  • Obesity;
  • Alcoholism;
  • Emphysema (chronic lung scarring) or chronic bronchitis;
  • Liver cirrhosis (scarring);
  • Chronic kidney disease;
  • Sleep apnea (stopped or shallow breathing while sleeping);
  • Prior illegal steroid use;
  • Other hormone imbalances;
  • Chronic pain that requires narcotic medications (other hormone declines may also occur);
  • Shortened telomeres. (Telomeres are the tips of chromosomes in cells that become shorter as we age.) 

How is the diagnosis of Andropause made?

As with all medical diagnoses, Andropause is diagnosed by a constellation of symptoms, blood measurements and physical examination by a physician who is qualified to make the diagnosis. Sometimes another abnormal test may be a tip-off for possible Andropause. For example, a bone fracture might indicate low bone density that would be measured on a scan. Low bone density is a possible abnormality of Andropause.

Why is it important to diagnose Andropause?

The diagnosis of Andropause is very important for several reasons. First, there are many studies indicating that men with low testosterone have a shorter lifespan than men with normal testosterone. And the earlier deaths are due to the common causes of death, including heart disease, cancer and stroke. Second, low testosterone is a risk factor for many common diseases of middle-age and elderly men. These include:

  • Artery blockages (atherosclerosis with risk of heart attack & stroke);
  • Diabetes and pre-diabetes;
  • Abnormal cholesterol;
  • Increased blood pressure;
  • Increased body fat in the mid-section (risk for heart attack);
  • Obesity and overweight;
  • "Metabolic Syndrome" (combination related to items 2-6 above);
  • Low bone density (osteopenia, osteoporosis) and risk for bone fracture and height loss; and
  • Likely increased risk for Alzheimer's disease (memory decline, dementia). Third, men with Andropause have a poorer quality-of-life, due to associated symptoms (not all men have all symptoms):
  • Lower energy;
  • Lower motivation;
  • Lower productivity;
  • Decline in libido;
  • Decline in quality of erections or even no erections;
  • Decline in sexual satisfaction;
  • Decline in physical capability for sports, athletics and physical work;
  • Decline in muscle mass;
  • Increase in body fat;
  • Possible decline in self-image; and
  • Risk for depression, anxiety, memory decline, and decreased mental concentration.

How is Andropause treated?

After a competent physician has diagnosed Andropause, the most common treatment is testosterone replacement therapy (there are other possible treatments). The most common testosterone treatment would be a gel, cream or patch on the skin or by injection (shot) in the muscle. Sometimes a specific cause for Andropause is found - when that cause is treated, the Andropause may resolve. Depending upon associated hormone imbalances other than testosterone itself, the treatment might be another hormone or hormone blocker.

What are the side effects of testosterone treatment?

A competent physician will know what side effects to monitor. Most men with Andropause who are treated with testosterone will not show side effects. Most of the side effects are minor and are manageable. They may include: increased red cell count in blood (treatable); acne (treatable); possible oily skin (treatable); increase in estrogen and nipple symptoms (treatable); increase in DHT and hair thinning (treatable); decrease in testicle size and sperm count (treatable); and possible increase in penis size (most men would not consider this a side effect that requires treatment).

Can my doctor tell me if I have Andropause?

Many doctors are not comfortable diagnosing and treating Andropause. This is because they may not have had specific training to do so. Some doctors only measure the total testosterone level in blood, which is insufficient to establish the diagnosis. Many doctors are unfamiliar with testing the hormones related to testosterone that may be imbalanced, either for diagnosing Andropause or for monitoring treatment. This is why many patients do not receive optimal treatment related to their Andropause. Also, media reports of illegal use of testosterone by athletes and celebrities tend to cause some doctors to be uncomfortable with diagnosing and treating Andropause.

Isn't testosterone illegal?

Andropause and specifically Hypogonadism have been defined in medical and endocrine (hormone) textbooks for decades. Medical treatment for Andropause is similarly described in those textbooks along with guidelines by the Endocrine Society and other medical societies. Legal prescribing of testosterone is regulated by the Food and Drug Administration (FDA), Department of Justice and many states in the US. However, testosterone (or bottles with labels claiming to contain testosterone) may be purchased illegally on the Internet and on the "black market." Self-prescribing and self-dosing is extremely dangerous and illegal. This author has seen patients who tried to self-treat, resulting in severe hormone imbalances, side effects, and many ill symptoms. As a group, many professional body builders and professional wrestlers generally die younger due to illegal usage of testosterone and side effects that are not monitored or detected.

If I have Andropause and don't get treated, what will happen?

You generally will have a poorer quality-of-life and will have a higher risk for many diseases and a shortened lifespan. [LINK TO '˜ Why is it important to diagnose Andropause' above] Are there medical studies of men with Andropause who have been treated with testosterone? Yes, there are many published studies of men with Andropause treated with testosterone therapy. Most of the studies are up to 1-2 years. (One study has lasted longer than 13 years.) In general, the results show that:

  • Energy improves;
  • Mood may improve;
  • Muscle mass and strength increases;
  • Body fat decreases;
  • Waist size decreases;
  • Libido generally improves;
  • Erections generally improve;
  • Sense of well being generally improves;
  • Blood glucose (sugar) and other markers of diabetes improve;
  • Triglycerides (blood fat) may improve;
  • Other disease markers may improve, including "metabolic syndrome;"
  • Bone density generally increases; and
  • Studies of heart function generally show improvements. 

Most medical studies do not last longer than 1-2 years, because men generally know when they have been prescribed testosterone (and not "placebo" inactive drug) because they feel better. Men who are given "placebo" do not feel better, and tend to drop out of the study, making it difficult to complete the study for longer than 1-2 years. There are published studies of men in Europe with Andropause and testosterone therapy for over 13 years, without significant side effects. With professional monitoring, testosterone treatment is safe.

Is testosterone treatment dangerous?

When a man is accurately diagnosed with Andropause and treated by an experienced and competent physician who is able to monitor the patient, testosterone treatment is not dangerous.

Does testosterone treatment cause cancer?

There has been a myth in the medical profession and in the lay public for decades that testosterone causes prostate cancer. In a 2008 review of 18 medical studies, the US National Cancer Institute reported that "sex hormones were not associated with risk of prostate cancer."Dr. Abraham Morgentaler, M.D., urologist at Harvard Medical School has published many medical articles in the last several years describing where this myth originated and why testosterone does not cause prostate cancer. Prostate cancer is a common cancer in men, so all men need regular check-ups for screening after the age of 40 years, including men without Andropause, men with Andropause and men with Andropause who have been prescribed testosterone therapy.

I have prostate cancer; is it safe to be prescribed testosterone?

Currently, men with active prostate cancer should not be prescribed testosterone. Dr. Morgentaler from Harvard Medical School (and other research physicians) have treated some men with active prostate cancer and Andropause with testosterone. However, currently this is considered experimental. Men who have recovered and been cured of their prostate cancer may possibly have testosterone treatment for Andropause, although close monitoring by an experienced physician would be required.

My doctor blocked my own testosterone as a treatment for my prostate; is this dangerous?

Sometimes, doctors prescribe medication to block testosterone production, usually as a treatment for prostate cancer. For every treatment, there are potential benefits and potential side effects and risks. There are published studies indicating that when compared to men without blocked testosterone, men with blocked testosterone are more likely to:

  • Develop diabetes and pre-diabetes;
  • Develop high blood fats (triglycerides);
  • Gain body fat in the mid-section;
  • Develop "metabolic syndrome" (combination of first 3 and possibly high blood pressure);
  • Lose muscle mass;
  • Develop bone thinning (osteoporosis and osteopenia);
  • Have a life-threatening bone fracture to due bone thinning;
  • Have a heart attack;
  • Die of a heart attack.

In addition, libido and erections generally would decline, along with possible energy and mood decline.

My doctor does not want to test my testosterone; what should I do?

Many physicians do not have the training or clinical experience to diagnose and treat Andropause. If your doctor does not want to test your testosterone, then it would be reasonable to find a physician who is comfortable and experienced in diagnosing and treating Andropause.

My testosterone is low, but my doctor does not want to treat me; what should I do?

Many physicians do not have the training or clinical experience to treat Andropause. If your doctor does not want to treat your Andropause, then it would be reasonable to find a physician who is experienced in diagnosing and treating Andropause.

Is testosterone a hormone for the whole body?

Yes, testosterone is a hormone for the entire body. In the past, physicians believed that testosterone was only important for libido, sperm production (fertility), erections, and maintaining muscle mass. We now understand in the 21st century that testosterone is an important hormone for nearly every organ in the body, for normal lifespan and quality-of-life. In addition, testosterone helps to regulate normal blood glucose (sugar), cholesterol, maintain muscle and bone strength, maintain normal artery function, and maintain and even improve normal heart function.

My doctor treated my Andropause with testosterone, but I don't feel any different; what should I do?

Testosterone can change into other hormones, and the dosing of testosterone should be monitored for optimal symptom improvement. Some physicians merely prescribe one dose and are not monitoring for improvements or other hormones that increase with testosterone treatment. Also, there are some treatable causes of Andropause that should be determined before starting treatment. If the treatable causes are not addressed, then patients might not be expected to have optimal improvements with testosterone treatment.

Is Andropause related to Gynecomastia?

Yes. Several conditions that can cause Gynecomastia also can cause Andropause. Also, Andropause itself might cause Gynecomastia or other conditions that could cause Gynecomastia. Patients with Andropause who are treated with testosterone require monitoring to make sure that Gynecomastia or precursors to Gynecomastia do not develop.

Is Andropause related to high cholesterol?

Yes. Men with andropause are more likely to develop abnormal cholesterol readings. Treatment with testosterone generally is associated with improvements in cholesterol levels, but there are several other co-factors for abnormal cholesterol.

Is Andropause related to diabetes?

Yes. Men with Andropause are much more likely to develop diabetes and pre-diabetes. The opposite is also true: men with diabetes and pre-diabetes are more likely to develop Andropause. There are now published studies indicating that men with diabetes who have Andropause and are treated with testosterone live longer than men with both conditions who are not treated with testosterone. Men with both conditions who are treated with testosterone generally have improvements in their diabetes and need less diabetes medication. They also feel better with increased energy, decreased body fat, improved libido, and improved erections.

Is Andropause related to dementia or Alzheimer's disease?

Probably. There are several published studies indicating that men with Andropause are more likely to develop Alzheimer's disease when followed over 10-20 years. However, not all studies show that association. In general, men with Andropause and some memory changes will report better memory with testosterone treatment. Other hormones and other co-factors may be involved also. Also, men who are treated to block their testosterone generally report memory decline.

Is Andropause related to Sleep Apnea?

Yes. Men with Sleep Apnea (stopped or shallow breathing while sleeping) are more likely to develop Andropause. Occasionally, when men with Apnea and Andropause are treated with testosterone, apnea may become worse. But generally, testosterone will lead to weight loss, particularly body fat loss, and apnea itself may improve. Men with apnea may require specific treatment with a breathing device to help maintain safe oxygen levels in blood.

Is Andropause linked with other hormone changes?

Yes. There are several hormones that decline with aging. Testosterone is only one of those hormones. People have better quality-of-life and decreased risk for diseases when all of the hormones are in balance, but professional diagnosis, treatment and monitoring is necessary.

I had mumps as an adult; could that be the reason for my Andropause?

Yes. Mumps virus can affect the testicles when the infection occurs during the teenage years or adulthood. Scarring could result, eventually leading to Andropause.

Is it true that fathers with small children should not be prescribed testosterone, even if they have Andropause?

No. Men with Andropause who are prescribed testosterone gel or cream for the skin need to be aware and take precautions so that there is no direct skin-to-skin contact with others, especially children. This is because the testosterone could rub off onto the other person, especially a child, which could be unsafe. When a father applies cream or gel to a skin area that is covered by clothing, transfer to the other person would not be expected to happen. During sexual contact with a spouse or partner, there could also be skin-to-skin transfer to the sex partner, so specific precautions need to be taken. This problem is easily manageable with education, information and simple precautions. Transfer would not occur from men who are receiving a regular injection (shot) of testosterone.

If my Andropause is treated with testosterone, won't I get '˜rhoid rage?'

When testosterone is prescribed and monitored by an experienced physician to make sure the levels are in a safe range, "rage" would not occur. Rage could occur when men use testosterone illegally, leading to levels that are dangerously high. In that situation, mood may become abnormal.

Was Barry Bonds' treatment at "Balco"due to Andropause?

According to news reports, several athletes including Barry Bonds were allegedly treated through Balco for sports "performance enhancement." This would be dangerous and illegal and would not be expected to be due to Andropause. The reports allegedly indicated that a "designer" testosterone was used called THG. This is not the same as naturally-occurring testosterone. Any synthetic testosterone that is not the exact same shape as naturally-occurring testosterone would be associated with side effects making it unhealthy.

I read that the pro-wrestler Chris Benoit was treated with testosterone with bad effects; is this true?

According to newspaper reports, the professional wrestler Chris Benoit was allegedly being treated with testosterone. However, those reports indicated that the levels were allegedly 10 times the normal range at the time of his untimely death. Sadly, according to news reports, he killed his wife and son and then committed suicide. This underscores why monitoring by a competent and experienced physician is so important and that treating for "performance enhancement" is dangerous.

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Dr. Bartnof is Founder and Medical Director at California Longevity and Vitality Medical Institute® in San Francisco, California. He is a graduate of University of California at San Francisco School of Medicine and Visiting Professor of Medicine at Shenyang Medical College and Liaoning Medical College in China. Dr. Bartnof is a member of the Endocrine Society and the Bio-Identical Hormone Society. He practices full-time Age Management Medicine, including Bio-Identical Hormone Replacement Therapy for men and women.



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