Andropause: Myth or reality?

Prof. Christoph A. Meier, Chefarzt Innere Medizin, Stadtspital Triemli, Birmensdorferstr. 497, 8063 Zürich

Andropause is mainly attributed to declining levels of several hormones, especially of the key male hormone testosterone. It is often referred to as the “Androgen decline of the ageing male” (ADAM) or “Partial androgen deficiency in aging males” (PADAM) is used. Andropause is not a new concept. The impact of testosterone imbalance has been described as a syndrome as early as in the 1940s. Unlike menopause the term andropause is not recognized by the WHO and its ICD-10 medical classification as a distinct disorder.

While true hypogonadism due to disorders of the pituitary gland or the testes is quite rare, an age-related decline of testosterone can frequently be observed. Indeed, 30-50% of elderly men show serum testosterone levels below the normal reference range.

However, while age is associated with decreased testosterone levels, as well as with decreased libido, decreased muscle size and strength, fatigue, and an increased frequency of erectile dysfunction, osteoporosis, depression etc., this association does not prove a given causality. Hence, we have to look at the evidence provided by trials substituting elderly men with androgens. These data, however, are quite disappointing, since they show very little benefit of testosterone replacement on clinically meaningful end-points in ageing males.

Moreover, it has to be kept in mind that testosterone replacement has potential short- and long-term side-effects, such as on the cardiovascular system or the prostate. Since replacement of testosterone in otherwise healthy ageing males provides little, if any, benefit in most patients, while not being without risks, the indication for such a treatment must be very carefully evaluated. Most importantly, before any substitutive treatment is started, an evaluation for a specific cause leading to testosterone deficiency must be performed.

Summing up it can be said that screening of ageing males for testosterone deficiency is not indicated and may lead to erroneous, costly and potentially harmful treatments. Hence, serum measurements of testosterone should only be performed in the small minority of males with a high clinical suspicion, and if the diagnosis of hypogonadism is confirmed, hormone replacement must be carefully monitored.

Handout SGIM 2008

27.06.2008 - dde