| c palmer 2006-07-23, 8:22 am |
| just for general information.........
~ curtis
=3D=3D=3D=3D=3D=3D=3D=3D
This article discusses andropause or viropause -- a syndrome associated
with lack of or absence of testosterone.=A0 Even in healthy men, by the
age of 55, the amount of testosterone secreted into the bloodstream is
significantly lower than it was just ten years before. In fact, by age
80, most male hormone levels have decreased to pre-puberty levels.
There are two general forms found in adult men who had normal hormone
levels through puberty and young adulthood and who experience normal
sexual development.=A0
One form, analogous to female menopause, as associated with the rapid
drop of testosterone levels.=A0 Typical symptoms of this include:
Fatigue, loss of a sense of well being -- 82%Joint aches and stiffness
of hands -- 60%Hot flashes, sleep disturbances -- 50%Depression --
70%Irritability and anger --
60%Reduced libido --
80%Reduced potency --
80%Premature aging
Changes in hair growth and skin quality
Sounds familar..... for women at midlife..... because it is the same
condition because the relationship between the ovaries, estrogen, the
brain, and the pituitary are exactly the same as the relationship
between the testis, testosterone, the brain, and the pituitary. =A0
Acute andropause in men is relatively uncommon, compared to acute
menopause in women, because testicular function declines gradually in
most men.=A0
There are a number of common causes, however, for acute testicular
failure in adult men and these include:
viral infections such as mumps (which fortunately has been eradiacated
by immunization)surgical removal of or surgical injury to the testis and
male reproductive tract ( testicular cancer, hernia repairs,
??vasectomies)diseases when the immune system attacks and destroys the
testis such as variations of systemic lupus erythematosissubtle genetic
abnormalities which permit normal adult development but lead to
premature testicular failure (such as chromosomal mosaicism)generalized
vascular diseases such as diabetes and perhaps even problems caused by
heavy smokingchemotherapypituitary tumors (very rare)
The second form of this syndrome is more insidious since it occurs
gradually.=A0 It is often confused with male midlife psychological
adjustment disorders because it exactly mimics depression in midlife
men.=A0 Male hormones decline gradually.=A0 Testosterone (from the
testis), human growth hormone (from the pituitary), and DHEA and
androstenedione (from the adrenal gland) all begin to drop.
=A0 For many men, this does not occur until their 60s or 70s but there
are older where it occurs much earlier.=A0 In addition, there is
proteins in the blood which bind testosterone in a biologically inactive
form.=A0 These are called sex human binding proteins or globulins.=A0
Their levels can rise in response to many conditions including medical
disorders and exposure to other hormones including phytoestrogens
(estrogens derived from plant sources such as soy) and other
environmental estrogen -like compounds (pesticides, hormones used in
agribusiness to produce fatter animals, etc.) =A0 As an example, there
is some data suggesting that men on low fat or vegetarian diets have
lower testosterone levels.=A0 The overall effect of rising sex hormone
binding proteins is that there is less bio-available testosterone.
Diagnosis
First, men need to disassociate their ego from their testicles.=A0 Men
needs to realize and accept that this disorder exists, that it is a
simple endocrine problem which is no different than thyroid disease or
diabetes, and that it can be treated. Spouses and employers also need to
be aware that this is real so they can identify these men at risk early
before their work, home, and families are disrupted.=A0 Perhaps, more
important, physicians, psychologists, and other health providers need to
be taught about this condition.=A0 The current paradigm in medicine is
that there is no biological basis for behavioral changes in midlife men
so it is ignored.=A0 But the diagnosis is quite simple--namely measuring
either free testosterone blood levels or, as recommended by Dr. Malcolm
Carruthers, computing the free androgen index <FAI>=A0 (total
testosterone x 100 /sex hormone binding globulin).=A0 There is some
controversy as to what level of testosterone in men is normal with low
end values ranging from 250-400ng/dl.
NORMAL ANDROGEN
LEVELSmeanrangeFree testosterone -- men700 ng/dl300-1100Free
testosterone -- women40 ng/dl15-70Free Androgen Index=A070-100%
At a free androgen index less than 50% , symptoms of andropause
appears.=A0 Of course, good medical care dictates that a comprehensive
medical and psychological assessment along with a thorough laboratory
assessment are necessary.
Testosterone Replacement Therapy
There is good evidence that testosterone levels drop as a man ages.=A0
There is a huge debate whether the testosterone level in older men
should be adjusted up the mean testosterone levels in younger men.
What are the risks?
Prostate cancer-- At autopsies, most men by age 50 have nests of
atypical cells in their prostate which look like prostate cancer
cells.=A0 There is a great deal of concern among urologists--
particularly in the US when medical malpractice suits are a major
concern-- that increasing testosterone levels might activate prostate
cancer.=A0 On the other hand, there is a good screening test called
Prostate Specific Antigen (PSA) which all men over age 50 should have
performed annually and which is relatively effective in detecting early
prostate cancer.=A0 There is no evidence in the medical literature that
testosterone replacement therapy increases the risk of prostate
cancer.Heart disease--there is a major concern that increasing male
androgen levels would also increase serum cholesterol and serum
LDL-Cholesterol levels.=A0 Oral methyltestosterone in particular will
raise blood cholesterol levels.=A0 This increases the risk for coronary
artery disease.=A0 On the other hand, "good" cholesterol
(HDL-Cholesterol increases with exercise.=A0 Men using testosterone
supplementation should have their serum lipids carefully evaluated and
rechecked periodically.Liver Disease--the only orally available forms of
testosterone for men in the USA contain methyltestosterone.=A0
Unfortunately, if used for sustained periods of time, it can damage the
liver.=A0
The Physicians Desk Reference cites several different forms of liver
damage from high dose methyl- testosterone including liver cancer,
cholestatic hepatitis, and other liver diseases.Suppression of
testicular function--As a general principle, whenever any hormone is
administered, the gland which normal produces it ceases to function and
recovery may be variable.=A0 Patients with borderline low testosterone
levels may commit themselves to lifelong therapy if they start with
testosterone replacement.
What are the benefits?
There is no doubt that the administration to testosterone to men with
true testosterone deficency states will improve their health and sense
of well being.=A0 The symptoms listed above will disappear.=A0
Unfortunately, impotence, or the inability to sustain and erection, does
not respond well to testosterone therapy except perhaps only in men with
severe hormone deficiencies.=A0 This comprises approximately 8-16% of
men presenting to physicians with erectile disorders.=A0 There is no
evidence that administering testosterone to men with borderline low
testosterone levels will improve sexual functioning.=A0 For more
information on erectile disorders, see our article on Impotence.
Forms of Testosterone for Men
Pills
Methyltestosterone (Android,Virilon,Testred, Oreton)=A0=A0=A0=A0 10mg,
25mg (not recommended)
Testosterone undecanoate (Restandol, Andriol) 40mg, essentially a
testosterone in oil preparation (not available in the USA)
Mesterolone (Proviron) 25mg -- less potent (not available in the USA)
Transdermal Preparations
Testosterone--transdermal (Testoderm, Testoderm TTS, Androderm)
Injections
The following forms of injectable testosterone is available in the USA.
Testosterone Cypionate 100 mg/ml Testosterone Propionate in Oil 100
mg/ml Testosterone Enanthanate 200 mg/ml
The usual dose is 1cc injected weekly or bi-weekly.=A0 This route of
administration eliminates the risk of liver damage which may be caused
by methyltestosterone as well as eliminating the theoretical risk of
changes in cholesterol caused by oral medications.=A0 The problem is
fluctuating hormone levels and the discomfort of administration.
knowledge is power - growing old is mandatory - growing wise is optional =
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
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