andropause

Andropause is a term used to describe a decline in testosterone levels that occurs with aging in men. It is also referred to as late-onset hypogonadism or age-related hypogonadism. Unlike the abrupt menopause seen in women, testosterone decline is typically gradual, and not all men experience clinically significant symptoms. The concept and terminology are sometimes debated, and some experts prefer to emphasize the condition as a syndrome related to aging rather than a distinct disease.

Symptoms associated with andropause can be diverse and may overlap with other medical or psychological conditions. Common signs include reduced libido and erectile function, fatigue, depressed mood or irritability, diminished motivation, decreased muscle mass and strength, increased body fat, and reduced bone density. Because these symptoms are nonspecific, a diagnosis requires both persistent symptoms and biochemical evidence of low testosterone.

Diagnosis typically involves confirming consistently low morning serum testosterone levels, usually on two separate occasions, alongside an assessment of symptoms. Screening questionnaires such as the Androgen Deficiency in Aging Males (ADAM) or Aging Male Symptoms (AMS) scale may be used but are not definitive.

Management focuses on treating symptoms and any underlying conditions. Testosterone replacement therapy (TRT) is an option for men with persistent symptoms and laboratory-confirmed low testosterone. Treatments include injections, gels or patches, and implantable formulations. Patients undergoing TRT require regular monitoring of testosterone levels, hematocrit, and prostate health (including PSA testing and digital rectal exams). Risks can include erythrocytosis, sleep apnea, acne, and potential cardiovascular or prostate-related effects; TRT is contraindicated in men with certain prostate cancers or breast cancers. Lifestyle modifications and management of comorbidities also play a role in care.