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Andropause (or male menopause[1]) is a rather misleading word, and a controversial concept. The word is sometimes used to describe a supposed medical phenomenon in middle-aged men. Proponents believe that it represents the effects of a reduction of the production of the hormones testosterone and dehydroepiandrosterone, and the consequences of that reduction,[2] which is associated with a decrease in Leydig cells.[3]

The term andropause is a misleading choice of terminology (as is the term "male menopause"), because it suggests an equivalence with menopause, a complete and permanent physiological shutting down of the reproductive system, which occurs only in women.

Unlike the term menopause, the word "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification.

There is on-going professional disagreement about whether or not andropause should be considered a normal "state" (the term used by MeSH), or a disorder. A steady decline in testosterone levels with age (in men and in women) is well documented,[4] but there is disagreement over how exactly a "normal" or "healthy" state should be defined.

Researchers who oppose the use of the term "andropause" may not object to the more limited terms "SLOH" or "ADAM", described in more detail below.

As a "state"Edit

The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers[5] identified symptoms of what they labeled the "male climacteric" including loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. Heller and Myers found that their subjects had lower than normal levels of testosterone, and that symptoms improved dramatically when patients were given replacement doses of testosterone.

Andropause has been observed in association with Alzheimer's disease.[6]

The term "symptomatic late onset hypogonadism" (or "SLOH") is sometimes considered to refer to the same condition as the word "andropause".[7] [8]

Some researchers prefer the term "androgen deficiency of the aging male" ("ADAM"), to more accurately reflect the fact that the loss of testosterone production is gradual and asymptotic[9] (in contrast to the more abrupt change associated with menopause [How to reference and link to summary or text].) The "D" is sometimes given as "decline" instead of "deficiency".[7] In some contexts, the term "partial androgen deficiency in aging males" ("PADAM") is used instead.[10]

As a "disorder"Edit

ProponentsEdit

Its proponents claim that it is a biological change experienced by men during their mid-life, and often compare it to female menopause. Menopause however is a complete cessation of reproductive ability caused by the shutting down of the female reproductive system in its entirety. Andropause is a diminishment of the male hormone testosterone. This drop in testosterone levels is considered to lead in some cases to loss of energy and concentration, depression, and mood swings. Unlike menopause, andropause does not cause a man's reproductive system to stop working altogether in mid-life, but many will experience bouts of impotence.

Some of the current popular interest in the concept of andropause has been fueled by the book Male Menopause, written by Jed Diamond, a lay person.[11] According to Diamond's view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, generally between the ages of 40 and 55, though it can occur as early as 35 or as late as 65. The term "male menopause" may be a misnomer, as unlike women, men's reproductive systems do not cease to work completely in mid-life; some men continue to father children late into their lives (at age 90 or older[12]). But Diamond claims that, in terms of other life impacts, women’s and men’s experience are somewhat similar phenomena.[13][14][15]

The concept of andropause is perhaps more widely accepted in Australia and some parts of Europe than it is in the United States.[16]

OpponentsEdit

Many clinicians believe that andropause is not a valid concept, because men can continue to reproduce into old age. Their reproductive systems do not stop working completely in midlife, and therefore they do not show the same sudden and dramatic drops in hormone levels that are characteristic of menopause in women.

Others feel that andropause is simply synonymous with hypogonadism or low testosterone levels.[15] Opposition is not limited to the US.[17]

Some clinicians argue that many of the cited symptoms are not specific enough to warrant describing a new condition as the cause. For example, people who are overweight may be misguided into treating a 'new illness' rather than addressing the lifestyle that lead to their being overweight. Similarly, energy levels vary from person to person, and for those people who are generally inactive, energy levels will automatically be lower overall.

While it is true that active and otherwise healthy men could in theory develop andropause-like symptoms, how common and widespread the phenomenon is, and whether genetics, lifestyle, environment, or a combination of factors are responsible, is not yet known.

Suggestions for treatmentEdit

Although there is disagreement over whether or not andropause is a condition to be "diagnosed" and "treated", those who support that position have made several proposals to address andropause and mitigate some of its effects.

  • Morley emphasizes the importance of response to treatment, as well as testosterone level and identifiable symptoms.[18]
  • Mintz, Dotson, & Mukai include an emphasis on hormones other than testosterone. They also focus upon diet, and exercise. [19]
  • Diamond (a lay person) believes that depression is one of the most common problems of men going through andropause, and feels it is greatly under-diagnosed in men, with serious consequences.[20]

Several intervention strategies have been found to be effective.[11] [14] [20] [16] These include:

Selective androgen receptor modulators have also been proposed.[22]

See alsoEdit

ReferencesEdit

  1. Male Menopause. URL accessed on 2007-12-17.
  2. MeSH Andropause
  3. Mahmoud A, Comhaire FH (2006). Mechanisms of disease: late-onset hypogonadism. Nat Clin Pract Urol 3 (8): 430–8.
  4. Mooradian AD, Korenman SG (2006). Management of the cardinal features of andropause. Am J Ther 13 (2): 145–60.
  5. Heller, C.G., Myers, G.B., “The Male climacteric: Its symptomatology, diagnosis and treatment.” JAMA 1944; 126:472-77.
  6. Fuller SJ, Tan RS, Martins RN (2007). Androgens in the etiology of Alzheimer's disease in aging men and possible therapeutic interventions. J. Alzheimers Dis. 12 (2): 129–42.
  7. 7.0 7.1 Columbia Presbyterian - Department of Urology. URL accessed on 2007-12-17.
  8. There's help for "grumpy old men", but they're reluctant to admit to problem, says Queen's urologist. URL accessed on 2007-12-17.
  9. Morales A (2004). Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies. Aging Male 7 (4): 297–303.
  10. Tancredi A, Reginster JY, Luyckx F, Legros JJ (2005). No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause'. Psychoneuroendocrinology 30 (7): 638–46.
  11. 11.0 11.1 Diamond, Jed (1998). Male Menopause, Naperville, Ill: Sourcebooks.
  12. "Father, 90, shows off new baby" - timesonline.co.uk, retrieved 9/08/07
  13. Cetel, Nancy (2002). Double Menopause: What to Do When Both You and Your Mate Have Hormonal Changes Together, New York: Wiley.
  14. 14.0 14.1 Diamond, Jed (2000). Surviving Male Menopause. A Guide for Women and Men, Naperville, Ill: Sourcebooks.
  15. 15.0 15.1 Tan, Robert S. (2001). The andropause mystery: unraveling truths about the male menopause, Houston, Tex: AMRED Pub.
  16. 16.0 16.1 Carruthers, Malcolm (2004). Androgen Deficiency in the Aging Male, London: Taylor & Francis Group.
  17. Juul A, Skakkebaek NE (2002). [Testosterone treatment of elderly men. The so called andropause doesn't exist]. Ugeskr. Laeg. 164 (42): 4941–2.
  18. Morley JE (2007). The diagnosis of late life hypogonadism. Aging Male 10 (4): 217–20.
  19. Mintz, A.P., Dotson, A. & Mukai, J. Hormone modulation, low glycemic nutrition, and exercise instruction: Effects on disease risk and quality of life. Journal of Anti-Aging Medicine, 4, 357-371, 2001. link
  20. 20.0 20.1 Diamond, Jed (2004). The Irritable Male Syndrome : Managing the Four Key Causes of Depression and Aggression, Emmaus, Pa: Rodale Books.
  21. 21.0 21.1 Tan, Robert S. (205). Aging Men's Health: A Case-Based Approach, New York: Thieme Medical Publishers.
  22. Tan RS, Pu SJ, Culberson JW (2003). Role of androgens in mild cognitive impairment and possible interventions during andropause. Med. Hypotheses 60 (3): 448–52.

External links Edit

See alsoEdit



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