A man’s testosterone level starts dropping by 1-1.5 per cent from age 30. When it falls below a critical level, a man will experience symptoms of this deficiency. This is popularly referred to as andropause. Andropause is viewed as the male equivalent of menopause, but it is, in fact, very different. Menopause is a clearly identifiable event, with specific symptoms occurring over a predictable time period and affecting all women. On the other hand, the onset of andropause is very variable. Some men never experience it; in others, it can occur over a wide age range from 40 to 80 years. And, there is no single characteristic symptom of andropause. Hence, while menopause is well established and widely discussed, andropause remains ill-understood and controversial.
Common symptoms of andropause are reduced sex drive, loss of morning erections, erectile dysfunction, low energy, fatigue, memory problems, muscle and bone weakness and depression. However, the testosterone levels at which symptoms appear vary from man to man, as do the symptoms and their intensity. Further, the symptoms attributed to andropause can also result from other medical conditions or may be a simple expression of ageing. As a result, the diagnosis of andropause can be difficult, and must be made only after a careful review of symptoms, repeated confirmation of low testosterone and exclusion of other medical causes.
If the symptoms are genuinely because of low testosterone, the benefit from testosterone therapy can be quite dramatic, and at followup the patient will come back beaming, saying he is a new man. Testosterone replacement drugs are available in capsules, gels or long-acting injections. Those who benefit can take it long-term, but must be monitored annually for any prostatic symptoms.
A word of caution: testosterone is not a substitute for healthy living. Many men come for testosterone testing actually hoping that their levels will be low, so that they can have a quick-fix to health problems with a simple injection of testosterone. In most cases, the testosterone level is normal and what they need is lifestyle changes with proper diet and exercise.
Shah is consultant andrologist and microsurgeon at Lilavati Hospital and Research Centre, Mumbai.