ANDROPAUSE
(Androgen Deficiency Of Aging Male (Adam))

Andropause :Andropause is a condition in which  male hormone testosterone & other male hormone Decreases with increasing age.  This can occur any time after the age of thirty years though it is more common after  the age of thirty  years. Andropause is also called as androgen deficiency of aging men i.e. (ADAM). This is similar to menopause in  women. In such people total testosterone & free testosterone decreases in concentration than what it used to be in  young age. This decrease in testosterone concentration below the previous value may still may be in  normal range (but in lower side). Thus in Andropause male hormone testosterone becomes lower then its previous value but still it can be in normal range.  In approximately 30% people testosterone concentration falls below normal level.

Causes of decreased testosterone are decreased function of testis as well as decreased function of hypothalamic pituitary glands. Other causes may be intercurrent illness, less physical activity & use of some drugs which is quiet common in old age.

Symptoms: This low testosterone results in diminished libido & decreased erection power (i.e. decrease in penile hardness), increased weight specially on abdomen, reduced muscle mass & strength, bone weakness, increased risk of fractures’ Low mood, depressed mood, and anxiety. Sometimes even decreased sleep may occur so this is one of the important cause of disorder, low libido & easy fatigability & above mentioned problems . Other symptoms of decreased testosterone value are weakness, decreased desire to genital, irritability, depression, anxiety, less body hair, breast enlargement, poor genital performance. After detail investigation for  other cause of male hormone deficiency. Testosterone replacement therapy is provided with gratifying results. 

Investigation & Diagnosis :

  Complete male hormone profile: This profile includes all the male hormone tests which affects testosterone

 production & other genital functions.

-         Serum testosterone is either below normal range or on the lower side of normal.

-         Similarly free testosterone is either low or on lower side of normal.

-          SHBG

         Other tests which may be required depending on likelihood of the any of above causes.  
Tests may show low testosterone. L.H. & F.S.H. may be decreased or may be normal. But for interpretation of all above tests one need to be expert of hormone diseases with good experience. Based on above test result diagnosis of cause of andropause is made, once the cause is found treatment becomes very simple. 

One need to do detailed investigations for other causes of low testosterone so that one does not misses any  serious underlying diseases.

Treatment :  Once the diagnosis of andropause is confirmed & other organic cause of low testosterone is excluded, then treatment as male hormone replacement started. Treatment with male hormone testosterone is available as  oral tablets,  skiin patch, skiin gels or injection is  given with very good results.Normally patient with andropause require very small doses of hormone as they have some production of their own. After start of treatment, erection & genital desire becomes normal. Physical weakness disappears & mentally becomes more active & alert. All other symptoms also normalizes. Bone strength recovers. Testosterone treatment is harmless if given by expert in hormone in proper doses. We monitor male hormone status regularly & maintain it normal range for that age.

 
The various preparation of testosterone & route of administration are: 

1)     Oral preparation that is available in capsule form. It need to be given one to three capsule daily. These have no side effects. 

2) Transdermal Testosterone given as testosterone gel preparations.  It need to be applied any part of skiin once a day. It is very effective & has no side effects. 

3).  Transdermal Testosterone scrotal patch are also available which are very effective even if used in small doses. It is very effective & has no side effects.

4)  Sublingual Testosterone cyclodextrin is now available which is very fast acting & very effective is fast & better response in Andropause. It is used as one tablet daily to be kept under the tongue for few minutes. It has no side effect and it is very effective.

5)  Local application of D.H.T. gel available as Andractim gel is a new preparation for male hormone replacement. 

6)  Injection Testosterone esters these includes Testosterone enanthate & testosterone cypionate given intramuscular injections every 10 to 14 days. 

7)  Long acting testosterone as testosterone bucilate given once in 4 months. 

8)  Testosterones implants are now available which once injected remain effective for up to six months. 

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