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Around a third of men in the 40 to 69 age group complain of a range of symptoms that commonly include, in order of importance, loss of libido, erectile dysfunction (inability to get or maintain an erection), depression and worsening memory and concentration. These are the classic symptoms of the male menopause, called the andropause and are associated with testosterone deficiency.
On the sexual front the most common symptoms of andropause are loss of potency, loss of sex drive and loss of morning erections. The most common psychological symptoms are mild to moderate depression, irritability and an early reduction in memory and mental concentration. Physical symptoms related to the andropause are similar to those experienced by women, including joint aches and pains, dry and thinning skin, occasionally sweating at night and the feeling that the body's thermostat has gone wrong inducing flushing.
Generally you're as young as your heart and brain, which largely depends on how good the circulation is to these two vital organs.
When HRT for women was first cautiously introduced over 30 years ago, doctors feared it might contribute to diseases of the blood vessels. Much to their surprise, actual experience has shown the reverse to be true. Women on HRT suffered half the number of heart attacks compared to women who were not. So, with some reluctance, doctors have begun to change their views and now generally say the treatment is positively indicated in women prone to heart disease.
The situation is the same with testosterone. Over the last 50 years, most doctors, including cardiologists, have taken the view that testosterone is bad for the heart, although several studies have shown lower levels of testosterone, and sometimes higher levels of oestrogen, in patients who later developed heart disease, than in normal control subjects the same age. Also it has been found that testosterone can prevent the type of spasm of the coronary arteries which causes angina.
This is the commonest presenting problem in male sexual dysfunction clinics and peaks at the time when the andropause appears.
Man's ability to have an erection is actually a recurring miracle of hydraulic engineering. Though it is difficult to say precisely what part testosterone plays in helping to produce erections, it certainly both primes the penis and triggers the chain of events which bring an erection about. It is surprising, but gratifying, how often when adequate testosterone therapy is given, all the symptoms of the andropause disappear within a few weeks or months, including erectile difficulties, particularly when other factors contributing to its onset or continuation are dealt with.
Even though it is more difficult to restore function than desire, unless the source of the problems is obviously psychological or mechanical, it seems logical to investigate the testosterone balance of the patient, and restore it to normal as the first stage of treatment. Even if erections are not greatly improved by this alone, libido and confidence usually are. Recent experience has shown that when Viagra and Testosterone are combined, they provide a cure for over 95% of impotence problems.
TRT has had a bad press due largely to concerns about abuse and over-dosage in athletes, and alleged dangerous effects on the prostate gland, heart and liver. The answer to these concerns in brief is that though different forms of testosterone treatment have been widely used for over 60 years, all the most up to date research is confirming the basic safety and effectiveness of testosterone treatment when correctly applied in the medical setting.
The essential full work-up before any man starts on testosterone treatment is designed specifically to exclude prostate problems. This on-going screening means that the patient on testosterone knows that he does not have prostate cancer. The latest evidence shows not only no increase in his chances of getting it with testosterone treatment, but that death rates from the condition are reduced by regular screening with the PSA and other tests.
Similarly, like female HRT, male HRT with testosterone is actually being shown to protect the heart and circulation, and reduce the risk factors for arterial degeneration. Also, provided the toxic form of Methyl Testosterone is avoided like the plague it is, other forms of carefully monitored testosterone treatment are safe for both heart and liver.
The First Steps... what you should do if you think you are Andropausal
1. Seek the advice of your General Practitioner, and tell him/her your symptoms, which are the most important factor in establishing a diagnosis.
2. A blood profile may be suggested, which needs to include not just total testosterone, but a test for free active testosterone, which is best obtained in the form of the Free Androgen Index (FAI) by calculation from the Sex Hormone Binding Globulin. Where this is not available, the free testosterone and the free-and-weakly bound testosterone can be used. The symptoms you are suffering are more important than the lab data, as accepted reference ranges vary widely.
If you are over 50, it is advisable to include a Prostate Specific Antigen test, and is mandatory before and after starting on testosterone treatment.