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Andropause, the male analog to menopause, may be associated with symptoms, such as weakened bones, decreased sex drive, testicular shrinkage, and an increase in nonobesity related breast enlargement called gynecomastia. The cluster of symptoms related to a natural decline in testosterone has been termed androgen deficiency of the aging male (ADAM). While this condition is lacks a specific diagnosis, more men may be asking their doctor if there is a way to manage symptoms. Testosterone replacement therapy (TRT) is an option, but it is not without its risks.
Testosterone is one of the male sex hormones—or androgens—responsible for the development of masculine characteristics. During puberty, testosterone initiates the enlargement of the penis and testes, growth of facial and pubic hair, deepening of the voice, increases in muscle mass and strength, and growth in height. In male adults, testosterone is involved in the maintenance of sex drive, production of sperm cells, male hair patterns, muscle mass, and bone mass.
As men age, their production of testosterone naturally declines. But this age-related hormonal decline is much less dramatic in men than in women. During menopause, the production of estrogen and progesterone decreases sharply in women. The drop in testosterone is much more subtle in men.
Low levels of testosterone have been associated with weakened bones, diabetes and cardiovascular disease rates, diminished sex drive, and muscle loss in aging men. Signs of low testosterone levels include:
If your doctor suspects your testosterone levels are low, a simple blood test can check it. But since testosterone levels fluctuate widely throughout the day, a single test may not be able to diagnose testosterone deficiency. Generally, the acceptable range of levels is between 250-1,000 nanograms per deciliter (ng/dL) for total testosterone.
While testosterone does decline with age, diseases and conditions that affect the testicles, pituitary gland, and hypothalamus may cause reductions in testosterone production. Various genetic conditions also affect testosterone levels. If your testosterone levels are abnormally low, your doctor may perform additional tests to look for underlying causes. If one of these diseases or conditions is detected, treatment of the underlying disorder may resolve the testosterone deficiency, or TRT may be indicated. Some medications may also cause a drop in testosterone. Diminished testosterone levels are a known complication of prolonged opioid and steroid use. Stopping their use may correct testosterone levels.
There are different delivery methods of TRT for clinically low testosterone levels in otherwise healthy men, such as pills, injections, patches or gels, and a tablet that adheres to the gum surface. TRT might benefit men who suffer the symptoms of low testosterone in a number of ways, including:
For years, menopausal women took hormone replacement therapy (HRT, a combination of estrogen and progesterone) to relieve symptoms of menopause and increase bone density. However, HRT has been linked with increased risk of breast cancer, heart disease, stroke, and blood clots. It is not clear at this point if testosterone therapy effects cardiovascular outcomes in men.
If you are considering this therapy, it is important to talk to your doctor about the potential harms and benefits.
National Institute on Aging
The Canadian Society of Endocrinology and Metabolism
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Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Male Reproduction and Urology. Androgen deficiency in the aging male. Fertil Steril. 2008;90(5 Suppl):S83-S87. Available at: http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Educational_Bulletins/Androgen_deficiency_in_the_aging(1).pdf.
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Last reviewed March 2017 by Michael Woods, MD, FAAP Last Updated: 3/10/2017