Both men and women undoubtedly experience symptoms related to reduced production of sex hormones (sex steroids) as they get older. These changes are inevitable, but affect individuals differently.
In men, the fall in sex hormone production is much more gradual, developing over decades rather than months or years. As such, the term ‘male menopause’, or andropause, is probably not accurate. Instead, experts prefer to talk about ‘Partial Androgen Deficiency of the Ageing Male’ (PADAM).
What are androgens?
Androgens are steroid hormones with specific effects on tissue growth (muscle, fat, skin, hair and others) and brain function. They play important roles in both men and women, but are produced in much larger quantities in men.
In men after puberty, the majority of androgens are produced by the testicles, mainly as testosterone.
Other androgens – dehydroepiandrostenedione (DHEA), its sulphate (DHEAS), and dihydrotestosterone (DHT) – are produced in the adrenal cortex, skin and liver. Several man-made androgens are also available.
Androgen deficiency can occur in younger men, and even in children and adolescents, as a result of testicular damage, genetic disorders or metabolic disorders.
It’s very important that they receive expert assessment by an endocrinologist at an early stage and receive androgen replacement therapy.
What are the symptoms of androgen deficiency?
The symptoms of PADAM are numerous and non-specific, so it is not an easy condition to diagnose. They include problems with the following.
Circulation and the nervous system
• hot flushes
• sweating
• insomnia
• nervousness.
Mood and cognitive (higher mental) function
• irritability and tiredness
• decreased sense of well-being
• lack of motivation
• low mental energy
• difficulty with short-term memory
• depression
• low self-esteem
• being easily frightened.
Masculinity and virility
• decreased vigor and physical energy
• diminished muscle strength.
Sexuality
• decreased interest in or desire for sex
• less sexual activity
• poor erections
• reduced quality of orgasm
• weakness of ejaculation
• reduced volume of ejaculated fluid.
Physical features include
• diminished muscle mass
• loss of body hair
• abdominal obesity.
What are the consequences of androgen deficiency (PADAM)?
Changes caused by PADAM could potentially affect health in several ways:
• increased risk of osteoporotic fracture and cardiovascular disease
• reduced general wellbeing
• depression
• cognitive impairment (problems with thought, concentration and memory)
• reduced physical strength
• sexual problems.
The symptoms, signs and metabolic consequences of androgen deficiency are largely reversible, and can be corrected by replacement therapy.
How is androgen deficiency (PADAM) diagnosed?
No definitive test for PADAM exists. Low blood levels of testosterone alone are insufficient to make the diagnosis.
The combination of several different suggestive symptoms and physical signs, together with low blood levels of testosterone, should raise suspicion that PADAM is present.
Treatment
Many doctors do not believe that PADAM exists and will not offer treatment. Others are ‘believers’ and see it everywhere. Some men take in testosterone supplements.
Men receiving testosterone supplements should have regular medical checks every three months for the first year of treatment, which must include a rectal examination of the prostate gland (which sits beneath the bladder producing fluids that nourish and protect sperm) and blood tests.