Evolution of Men: "Men" O Pause

As men age, one of the biological changes they experience is andropause. Andropause, also called male menopause, is sometimes used to describe a reduction of the production of certain hormones such as testosterone. It is a normal part of ageing, and for some men, it is accompanied by a gradual and undesired decline in their sexuality, mood and overall energy. Sometimes, it can even expose men to more serious health risks.

Similar to the female menopause, men are affected by the onset of andropause between the ages of 40 to 55. Unlike women, however, the symptoms of andropause are not as widely researched, and as such, men do not have a clear signal when they are entering the andropause stage. The main indicator is a drop in the testosterone level, as well as accompanying physical and psychological changes. A decline in testosterone level can also increase the health risk for the men in the areas of heart and bones.

Most men, however, will experience some kind of mid-life crisis when they start to grapple with questions relating to their careers, values, accomplishments, direction in life and self-worth as they
began the process of internal reflection.

Going downhill

A man’s transition to an andropause stage is more gradual and takes place over a period of time, unlike women. Attitude, psychological stress, alcohol, injuries or surgery, medications, obesity and infections can contribute to its onset.It is common fact that as a man ages, his testosterone level will decline. However, there is no dipstick measure to find out which man will experience andropausal symptoms of a certain severity, which necessitates seeking medical help. It is also difficult to predict at what age the symptoms will occur in a particular individual. Each man’s symptoms may also be different and vary with the others.

Causes

After age 30, men will experience a decline in their testosterone levels which drop by about 10% every decade. At the same time, another hormone known as the Sex Binding Hormone Globulin, (SHBG), is increasing. SHBG traps much of the testosterone that is still circulating and makes it unavailable to exert its effects in the body’s tissues. What remains is known as “bioavailable” testosterone.

Andropause is associated with low bioavailable testosterone levels. Every man experiences a decline of bioavailable testosterone but some men’s levels dip lower than others. When there is a lowering of bioavailable testosterone, men can experience andropausal symptoms. These symptoms can impact their quality of life and may expose them to other, longerterm risks of low-testosterone. Testosterone is important as it helps to build protein and is essential for normal sexual behavior and for producing erections. It also affects many metabolic activities such as the production of blood cells in the bone marrow, bone formation, lipid metabolism, carbohydrate
metabolism, liver function and prostate gland growth.

Are You Andropausal?

Men with low bioavailable testosterone levels will find themselves experiencing some of the following:

· Low sex drive
· Emotional, psychological and behavioral changes
· Decreased muscle mass

· Loss of muscle strength
· Increased upper and central body fat
· Osteoporosis or weak bones and back pain
· Cardiovascular risk

Treatment for Andropause

According to Dr Eng Soo Kiang, Family Physician, Raffles HealthScreeners, some treatment options that are found to be effective are:

· Exercise, dietary changes, stress reduction
· Couple counselling, career refocusing, spiritual support
· Treatment for depression
· Chemical dependency treatment, sexual compulsivity treatment
· Androgen Replacement Therapy

Androgen Replacement Therapy (ART)

The most important factor in the evaluation and treatment of andropause is the public awareness of its frequent occurrence that will stimulate the use of appropriate screening tests, beginning
with a morning testosterone level.

“ART has been shown to produce improvements in many of these areas. ART can be highly beneficial in alleviating the symptoms of andropause and improving quality of life,” said Dr Eng.

He added that this practice is not without risks, both proven and theoretic. Additionally, the diagnosis of androgen deficiency and the decision to treat is not always straightforward. It is
necessary to have careful screening and meticulous follow-ups. It is essential for anyone that the following criteria are met before using ART:

- The presence of symptoms and blood tests supporting the diagnosis
- Conditions that make ART undesirable must be screened for
- A doctor familiar with the diagnosis, treatment and monitoring of andropause
- Patient is well-informed and is committed to diligent and competent follow-ups for the duration of the treatment

Patients can also enquire if the doctor is sited in a multi-disciplinary centre where there are other specialties to look after the diverse and complex needs of an andropausal man. For example, an
urologist, endocrinologist, psychiatrist, cardiologist, ear, nose and throat specialist, dietician, exercise therapist, clinical psychologist, sex therapist and other complementary health practitioners.

Treatment Steps for ART

Dr Eng advises that men should seek a specialist doctor in andrology and men’s health to draw up a comprehensive care plan jointly that is both acceptable and beneficial to him. It involves:

- Medical nutrition
- Precise exercise prescription
- Sleep optimisation
- Smoke cessation
- Cancer screening
- Liver and bone care
- Sex therapy, marital and fertility assistance
- Diabetes, cholesterol and hypertension co-management
- Orchestrating community / social support system for patient
- Attention to the multifaceted male gender role
- Individualised androgen replacement therapy