Over the past few years, I have come across several cases where couples come to me for treatment related to infertility and other problems in their marital life. It is always easy to hold the woman responsible for fertility and if there is something wrong, the first thought goes in the direction of the woman involved. Is her health fine? Is her system supporting conception and child birth?
We often tend to overlook the fact that just as women face age-related problems concerning reproduction, so do men. Women are not an exception in facing or undergoing age-related hormonal changes in the body. Men have to go through this too. These changes are all grouped together under a simple term for men – Andropause.
Andropause, also popularly known as the androgen deficiency of the ageing male (ADAM) or male menopause, is a term that relates to a reduction in the production of two hormones primarily in middle-aged men – testosterone and dehydroepiandrosterone (DHEA).
The consequences of lowered hormone levels in the body are associated with a decrease in Leydig cells (cells within the testicle that secrete testosterone) generating symptoms such as loss of libido, impotence, nervousness, depression, irritability, decreased muscle mass and strength, impaired memory, an inability to concentrate, fatigue, insomnia, hot flushes and sweating.
It is clear that andropause is a phenomenon that affects ageing men at all three levels – physical, mental and emotional/ psychological. What makes andropause controversial is the fact that not all ageing men experience low testosterone levels. Some older men never develop it.
Another unique thing about male menopause is that it sets in slowly, over a period of a few decades. It is a gradual process unlike female menopause where ovulation suddenly stops and other symptoms also set in quickly. It is these differences in the onset of andropause that have given the condition its many names.
As per statistics, about 30 per cent of men in their 50s experience andropause. Globally, there is on-going professional disagreement about whether or not ‘andropause’ should be considered a normal ‘state’ or a disorder. Unlike ‘menopause’, the World Health Organization’s medical classification does not currently recognize the word ‘andropause’.
Onset and Risk Factors
Andropause is generally the result of gradual testosterone reduction over the years and an increase in another hormone called ‘sex hormone binding globulin’ (SHBG) in the body. What SHBG does in our system is that it pulls usable testosterone from the blood. As its name implies, the function of this hormone is to bind the available testosterone circulating in the blood. An increase in SHBG reduces bioavailable testosterone in our body – bioavailable here refers to ‘available for use’ by the body.
These changes start around 35 years; testosterone reduction progresses with approximately a 10 per cent decline every decade after the age of 30. Premature andropause can occur in males, who experience excessive female hormone stimulation through workplace exposure to oestrogen. For instance, men who work in the pharmaceutical industry, plastic factories, near incinerators, and on farms that use pesticides, are at high risk for early andropause.
Factors that can hasten the decline in testosterone and worsen the symptoms experienced during andropause include:
■ Age
■ Hypothyroidism
■ Adrenal insufficiency
■ Stress
■ Toxicity (pesticides, smoking, alcohol, heavy metals)
■ Diet / Insulin Resistance
Symptoms and Signs
Though andropause sets in over a gradual period of time, there are certain symptoms that may signal dropping testosterone levels in the male body. If these symptoms are bothering you, you may want to consult your doctor and share your concerns with him.
Andropause may bring about certain changes in the sexual function of an ageing male. A person going through andropause may experience decreased libido, erectile dysfunction (difficulty in maintaining an erection), impotence and reduced sexual desire. This may affect fertility in the long term.
Source: New Indian Express