State of the Art Anti-Aging Practice: Diagnostic Difficulties of the Andropause

Even before contemplating hormonal replacement for men, practitioners should be certain of a diagnosis of low testosterone causing andropause-related symptoms. This is partly because accurate diagnose may be confounded due to factors such as clinical depression, hypothyroidism, anemia, alcoholism, psychological states, and side effects of medications. There is undeniable evidence that bioavailable testosterone declines with age. However, there are variations in testosterone measures based on timing and method used for quantification, and this will be explored in this chapter. There are limitations of blood and saliva measurements of testosterone, and andropause should be diagnosed only in conjunction with a clinical assessment, as it is a complex syndrome. The decline of testosterone leads to hypogonadism, which can present with symptoms in older men. However, like in the menopause, not all older men present with transitional symptoms as they enter the andropause. The long-term effects of andropause in men may be similar to menopause, as decline in androgens can affect libido, musculoskeletal, cardiac, and cognitive functions. In addition, in contrast to menopause, men in andropause do not necessarily suffer from infertility as sperm production continues. The evidence of the impact of low testosterone on the aging male's physiology will be examined. Androgen supplementation in the form of testosterone may be effective for some individuals who are symptomatic. At the present time, is no routine recommendation for androgen replacement in all males. The practitioner should select his patient carefully based on symptoms and biochemical evidence of hypogonadism. Monitoring of side effects of androgens, including changes in prostate, hemoglobin levels, etc., is mandatory.