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The term Andropause has gained acceptance when referring to the male climacteric or mid-life crisis. Clinical symptoms can occur when levels of androgens, especially testosterone, begin to decline in the fourth decade of life. Testosterone is a hormone produced from cholesterol in the testes, but women produce small amounts of testosterone too in the adrenal glands. It regulates all protein structure, including bone growth. Testosterone can be converted to estrogen. Cessation of menstruation signals the onset of menopause in women. There is no comparable event in men. It is a slow gradual process. One clue is the mild erectile dysfunction with reduced libido and a decrease in performance. Other clinical clues include depression, irritability and fatigue. Sweating and hot flushes have also been reported. Loss of interest in life's pleasures, including sports, hobbies and friends may be a signal. Loss of backbone mass reduces height, and couch napping is substituted for endurance.
Anyone showing these symptoms deserves a full evaluation. A physical examination to rule out prostate problems is usually the start. Newer blood tests can measure first morning bio-available testosterone. Unfortunately, blood values don't always correlate well with symptoms, suggesting other factors may be involved. Blood testing can also spot other problems such as elevated PSA levels, diabetes, elevated lipids and other endocrine disorders. X-rays can evaluate bone mass. There are several avenues of treatment available depending on the clinical presentation. Testosterone replacement is one option. It may be combined with anti-depressant therapy or the addition of sildenafil (viagra). Results can be dramatic. Low testosterone levels have been linked to heart disease and osteoporosis. Testosterone is currently available in a multi-dose pill with newer gel and patch versions. Its use should be carefully monitored. It is not a solution for certain cancer patients, persons with sleep apnea and those with urinary obstruction. Women can also suffer from testosterone deficiencies. So, if you find that your fellow is just not himself anymore, it just might be Andropause.
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