Andropause

If a man is not interested in producing sperm, then testosterone replacement can be very beneficial in men suffering from “andropause”. Andropause is a syndrome when a man’s testosterone gradually drops to a level that he begins to lose some of his “male” characteristics. This process typically begins in the 40’s and becomes most pronounced in the 60’s. An estimated 10 million men suffer from andropause. Exactly why some men’s testosterone begins to drop to levels that affect his most basic interests is unknown. Common symptoms include loss of libido, decreased
energy, poor sleep, weight gain, decreased competitiveness and erectile dysfunction. Any man with these symptoms should be offered a blood test for testosterone, free testosterone, estradiol, DHEA and prolactin. The goal of testosterone replacement therapy is giving enough testosterone to maintain normal blood levels and reverse the low testosterone symptoms. The most popular forms of testosterone replacement include bi-monthly shots or daily patches or gels. All modes of delivery work well at restoring low testosterone levels. A man may need to experiment with one or two until he decides which type of testosterone right for him.




What should be tested before beginning testosterone replacement?

Prior to beginning testosterone replacement therapy, the man needs to have a baseline urologic exam and PSA blood test. As testosterone stimulates prostate growth and fuels any existing prostate cancer, all men prior to beginning testosterone replacement therapy need to be screened for prostate cancer and prostate enlargement symptoms. In addition, men with sleep apnea and breast cancer should never receive testosterone for fear of exacerbating either condition. Once a man has his baseline studies and is deemed a good candidate for replacement, he needs his PSA and testosterone levels checked at the 3-month mark. If the blood testosterone increases to a normal level and the PSA increases by less than .4 ng/dl, then therapy can continue safely. While on replacement testosterone, a man should have his PSA checked twice a year rather than once a year. This will improve detection of prostate abnormalities. If the man while on adequate replacement does not have reversal of his “andropause” symptoms, then a low testosterone was not the source of his problems. Other possible sources for “andropause” type symptoms include hypothyroidism, depression and stress.