John is 56 years and has always enjoyed good health but in the last few years he has noted that despite any obvious health problems, he is fatigued by mid-afternoon. He has just had an executive physical and was told that everything was normal. Life is good but he seems to be having bouts of depression for no good reason. He is getting a little spare tire around his middle. He is not sleeping well and has become more irritable with his family. His sex life is not what it used to be and this is causing all kinds of problems with his wife. He thinks he is just getting older.
TESTOSTERONE DECLINES WITH AGING
John’s condition occurs in about 30% of men. While menopause occurs in 100% of women, men have the potential to be virile up until their 80’s and 90’s. There is well- documented evidence of paternity achieved by men over 90 years of age. Nonetheless, there appears to be an age-associated decline in testosterone production in many men.
IS THERE REALLY A MALE MENOPAUSE?
Lower testosterone levels may begin as early as the 40’s and 50’s. This has been referred to as male menopause or Andropause. If a man has a permanent decline in testosterone production, it should be treated. However, in contradistinction to women, male menopause can be a reversible phenomenon.
OTHER CAUSES FOR LOW TESTOSTERONE
Many factors can cause testosterone levels to decline. Before starting long-term testosterone replacement, a man should be carefully evaluated to determine the cause of his low testosterone.
Pituitary or brain tumors can result in low testosterone and these may require surgery or other drugs. Failure to recognize this serious condition could be life threatening.
Prescription drugs may interfere with sexual function and reduce testosterone levels.
Other less serious but treatable causes can include nutritional factors, stress, insomnia and other life-style issues. However, the good news is that when these are recognized and treated, testosterone may normalize without the need for testosterone treatment. The goal should be to enable a man to produce his own testosterone.
VIAGRA MAY NOT BE THE ANSWER
Viagra is a useful drug, which offers men an effective way to treat erectile dysfunction. However, erectile dysfunction is one of the key symptoms for low testosterone. Taking Viagra without undergoing endocrine evaluation could delay detection of a potentially treatable condition.
Appropriate hormone treatment could eliminate the need for Viagra and enable the man to have normal sexual function.
FIND OUT IF YOU MIGHT HAVE ANDROPAUSE
The following questionnaire, the Androgen Deficiency in Aging Males (ADAM) questionnaire was developed at St. Louis University Medical School to detect the symptoms related to decreased testosterone levels in older men.
The questionnaire contains the following ten questions:
1. Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength, endurance, or both?
4. Have you lost height?
5. Have you noticed a decreased enjoyment of life?
6. Are you sad, grumpy, or both?
7. Are your erections less strong?
8. Have you noted a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?
Any man answering “yes” to question 1 or 7 or any three other questions has a high likelihood of having a low testosterone level and should see his endocrinologist to be evaluated.
If testosterone is low on appropriate testing, most of these symptoms are reversed or improved with testosterone replacement.
ENDOCRINOLOGISTS - THE HORMONE SPECIALISTS
Endocrinologists are physicians who specialize in the diagnosis and treatment of all hormone disorders, including testosterone deficiency. They are uniquely qualified to do appropriate diagnostic testing to determine the cause of low testosterone and determine the best therapy.
Baby boomers are increasing the population of older adults and therefore there is a keen interest in preventing age-related dysfunction and prolonging quality of life. Women have benefited markedly from the use of bioidentical estrogen replacement. Men deserve to be given the same consideration to prolong quality of life and protect against age-related dysfunction.