Andropause is a misnomer for the clinical picture resulting from the progressive decrease in androgen production observed in at least 20% of 60-70 year-old males, sometimes starting at the age of 50. A more appropriate designation is partial androgen deficiency of the aging male. As testosterone production declines steadily, at age 75y. plasma testosterone levels are only 65% of levels in young adults, whereas over 25% of these men have subnormal bioavailable testosterone levels. The ethiology of this age-related testosterone decline is multifactorial and involves primary testicular changes, disturbed neuroendocrine gonadotropin regulation, increased sex-hormone binding globulin serum concentrations and reduced androgen receptor sensitivity. Aging is accompanied by a series of signs and symptoms, many of which are rather similar to those observed in young hypogonadal males. This complex clinical picture may arise from the concurrent effects of the aging process per se and intercurrent diseases. Nevertheless, there is good evidence that the age associated decrease in testosterone levels is at least a co-determinant of this clinical picture, seen that testosterone supplementation has shown favorable effects in more than 30% of these symptomatic aging males. At the moment, androgen supplementation should only be considered in the presence of serum levels below the lower normal limit for younger men, together with unequivocal signs and symptoms of androgen deficiency, in the absence of other reversible causes of hypoandrogenism and after screening for contra-indications.
Andropause; Androgens; Testosterone; Androgen insufficiency; Androgen replacement
