There has been much talk lately of “male menopause” or “andropause” in conjunction with androgen deficiency – particularly where older men are concerned. If you’ve heard anything about this, it may have caused you some concern.
After all, you might be thinking, “but I thought menopause had to do with lady parts – and I’m a MAN! – and ‘andropause’ isn’t even a word… is it?” For starters, these terms are not scientific and can be somewhat misleading. There can be multiple reasons for a hormonal imbalance, as we will discuss later.
What are androgens anyway?
More importantly, what’s so bad about a deficiency, and what can be done to remedy it?
Androgens are the group of hormones that cause the development of male characteristics such as beard and body hair, a deeper voice, as well as bone and muscle development. They are primarily responsible for sexual and reproductive development and function.
Testosterone is the main sex hormone in men, and is produced primarily by the testes under stimulation from the pituitary gland. The pituitary gland is controlled by a pearl-sized part of the brain called the hypothalamus.
To a lesser degree, the adrenal glands in both men and women produce a small quantity of androgens.
Why is testosterone so important?
Men are often referred to as being “testosterone fueled”, and this idea isn’t far off the mark. Testosterone is responsible for most of what makes men masculine, including sexual drive.
Testosterone really kicks in when puberty hits, and in fact is responsible for when puberty begins and ends. It causes hair growth on the face and body, and changes the vocal cords bringing the voice to a lower octave as a young man grows to adulthood.
After puberty, however, testosterone still plays a major role in a man’s life. It is the driving force behind a man’s sexual function and sex drive (or libido). It is responsible for sperm production, as well as prostate growth and health. So as you can see, an androgen deficiency can potentially be somewhat catastrophic for the unsuspecting male.
So what exactly is an androgen deficiency?
Androgen deficiency in men describes low levels of male hormones in general, and a deficit of testosterone in particular. This deficiency can be the cause of several unpleasant symptoms, and can usually be traced to problems in the testicles or the pituitary gland. At times, the deficiency can also be traced to the hypothalamus
A deficiency of androgens does not always have the same effects, however. Much depends on a man’s age. The severity of the deficiency also plays a large role in how noticeable the side effects are.
The age factor is what often results in the “male menopause” label. The fact is though, while all women experience the major mid-life hormone shift of menopause, only a percentage of men ever have a noticeable drop in hormone levels.
How will I know if I have a deficiency?
There is quite a wide range of symptoms that can stem from low levels of testosterone. These symptoms can be as mild as lethargy and fatigue, to male hot flashes, loss of body hair, and increased body fat, to more serious symptoms like reduced bone and muscle mass and high levels of bad cholesterol.
Androgen deficiency typically affects sexual function as well. You may see a reduced sexual desire; and (when you are aroused) weaker erections and orgasm. You may also have a decrease in ejaculate.
Many of these symptoms are not particular to testosterone deficiency, however, and can instead be traced to other disorders or conditions. If you are concerned about one or more of these symptoms, discuss them with your doctor as they may or may not be related to your testosterone levels.
What causes androgen deficiency?
As we discussed, an androgen deficiency can be traced to a few specific sources. Here we simply follow the chain of command:
1. The testes
A medical condition – either genetic or due to external causes – can hinder or halt testosterone production. Occasionally, a genetic condition is present from birth that negatively affects the sex hormones. In other cases, the testicles don’t descend properly or are lost due to injury. Sickness (i.e. mumps) also can result in long-term damage that hinders testosterone production.
2. The pituitary gland
If the pituitary gland is the source of trouble, it is most likely due to the presence of a tumor. This can affect the gland in two ways. First, as the tumor grows it tends to interfere with the function of the pituitary gland. Otherwise, a tumor occasionally produces hormones that interfere with the signals the pituitary gland is sending. Since the testicles rely on the pituitary gland for instructions, the testes simply cease production when the signal is interrupted.
3. The hypothalamus
The hypothalamus is the big boss here, and while it is rare for it to be the source of trouble, occasionally androgen deficiency can be traced all the way to the top. A tumor or congenital abnormality can interfere with the functions of the hypothalamus, preventing it from sending signals to the pituitary gland. Thus, the pituitary gland doesn’t pass the message on to the testicles. The testicles, simply following orders, fail to produce testosterone.
How can androgen deficiency be diagnosed?
If you suspect you might be suffering from androgen deficiency, it would be wise to discuss it with your doctor. Tests can be performed to properly diagnose where the problem lies, and thus, the correct treatment can be provided. To determine the source of your symptoms, your doctor will investigate a few different areas.
A full medical examination is a likely start. Your doctor will give you a thorough once-over, paying specific attention to certain areas. Your testicles will be measured, and you will be checked for unusual breast changes or development.
Next, your doctor will take some blood tests to determine your testosterone levels. Since your body releases the most testosterone first thing in the morning, you will probably need to go in to draw blood on two separate mornings (to ensure an accurate reading). At this point, the doctor will probably measure your pituitary gland as well.
Your doctor will ask questions about your medical history, starting with the basics (drug/alcohol/tobacco use, occupation, any other medical problems) and going on to more specific details about your sexual history, fertility, sexual function, and other relevant areas. He may also discuss family history to see if there may be a genetic connection.
If necessary, your doctor will perform other tests to further ascertain the cause. He may test your iron levels, run CT scans and genetic tests, and possibly analyze your semen.
Can a deficiency be treated?
The good news is that yes, androgen deficiency is fully treatable. If this is your confirmed diagnosis, you may receive some form of testosterone replacement therapy. Depending on your particular need, treatments can be taken orally in a tablet, topically in a gel or skin patch, or internally in a series of injections.
As you receive treatment, you will continue to visit with your doctor so that he can monitor your progress and review your condition.