The concept of the Andropause (Male Menopause) is still considered controversial, but the latest research has finally officially identified the symptoms associated with a reduction in testosterone in older men. This finding is accompanied with disclaimer that unlike the female menopause, which affects all women, the male menopause is relatively rare, affecting only 2% of elderly men, and is often linked to poor general health and obesity.
The link between the decline in testosterone levels seen in older men and late-onset hypogonadism (also known as male menopause) has long been a subject of debate. Now, for the first time, investigators have identified the symptoms of this condition and published their findings in the New England Journal of Medicine.
To establish the list of symptoms, the University of Manchester researchers, working with colleagues at Imperial College London, UCL (University College London) and other European partners, led by Dr. Fred Wu, a professor at The University of Manchester’s School of Biomedicine, surveyed a sample of 3,369 men aged 40 to 79 from eight different European centers. All the participants answered questions related to their general, sexual, psychological, and physical health.
Blood samples were collected from the men to determine their free and total testosterone levels. Free testosterone is the amount of the hormone present in the bloodstream that is not bound to protein. It comprises 2 percent of the testosterone in the body and is the biologically active form of the hormone. Total testosterone is the amount of both bound (and biologically inactive) and unbound testosterone.
The researchers selected three sexual, three physical, and three psychological symptoms they believe to be significantly linked with low testosterone levels. The three strongest indicators of male menopause were found to be in the sexual category: decreased frequency of morning erections, erectile dysfunction, and a decreased frequency of sexual thoughts. The lower a man’s testosterone levels, the more sexual symptoms he had.
The remaining six symptoms were only weakly linked to low levels of testosterone: loss of energy, sadness, fatigue, an inability to walk more than 1 km, an inability to participate in vigorous activity, and an inability to stoop, bend, or kneel. Overall, Dr. Wu noted that male menopause is often associated with poor overall health and obesity.
The results of the new study have established that the definition of late-onset hypogonadism, or male menopause, is “the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter).”
Dr. Wu and his colleagues also ruled out certain symptoms that have been linked with male menopause in the past, but which did not show any significant link with low testosterone levels, including poor concentration, anxiety, nervousness, changes in sleep habits, feelings of worthlessness, and trouble getting out of a chair.
One reason for the interest in this condition is the 400 percent increase in the United States in the practice of prescribing testosterone therapy. However, Dr. Wu explained that this hormone treatment “may only be useful in a relatively small number of cases where androgen deficiency is suspected,” because they found that many of the symptoms of hypogonadism were not associated with low levels of testosterone in older males.
The research, part of the European Union-funded European Male Ageing Study, also identified the thresholds of testosterone below which certain symptoms become increasingly prevalent. Documentation of levels of testosterone below these thresholds is required to confirm the diagnosis of hypogonadism in symptomatic elderly men.
However, even with the nine rigorously selected symptoms, differences in testosterone levels between symptomatic and non-symptomatic men were marginal, highlighting the weak overall association between symptoms and testosterone levels.
Professor Wu added: “The long list of nonspecific symptoms that have a potential association with testosterone deficiency makes it difficult to establish a clear diagnosis of late-onset hypogonadism. This situation is further complicated when you consider that even the most specific sexual symptoms of androgen deficiency was relatively common among men with normal testosterone levels.
“It is therefore important to specify the presence of all three sexual symptoms of the nine testosterone-related symptoms we identified, together with low testosterone, in order to increase the probability of correctly diagnosing late-onset hypogonadism. The application of these new criteria should guard against the excessive diagnosis of hypogonadism and curb the unwise use of testosterone therapy in older men.”
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