Holistic Approaches to Treating Andropause

A ndropause has been increasingly discussed in the media in recent years. Originally described as the “male climacteric,” in a Journal of the American Medical Association (JAMA)1 paper in the mid-1940s, andropause has gained much attention lately among medical providers. In the JAMA study, Heller and Myers reported the benefits of testosterone replacement for relieving andropausal symptoms, thereby establishing the condition as an actual medical problem warranting replacement/treatment. Although the case for andropause was established so long ago, several conflicting theories about the validity of andropause as an actual medical condition have prevented it from receiving much-needed at tent ion, and a confusing label—“male menopause”—has also created problems with recognition. In addition, relatively inconvenient treatments coupled with men’s notorious discomfort with seeking medical care (women visit the doctor roughly 150 percent more frequently than men) have kept andropause on the “back burner” of medicine. The term andropause refers to a condition of lowered androgens, including testosterone, dehydroepiandrosterone (DHEA), and androstenedione. Incorrectly referred to as “male hormones,” these substances are found in both men and women. Peaking in the early to mid 20s, testosterone then begins a slow decline; each year thereafter the body’s total testosterone level declines roughly by 1.6 percent, free testosterone by 2 percent, and bioavailable testosterone by 2.5 percent. Further compounding of this problem is a rise in sex hormone–binding globulin (SHBG) of roughly 1.6 percent per year.2 Based on measurements of total testosterone, approximately 20 percent of men over 55 are considered hypogonadal3 and, when this condition is based on levels of bioavailable testosterone, 50 percent of men age 50 and over are considered hypogonadal.4