In recent years we have witnessed a growing interest in male ageing and its consequences.  This new enthusiasm is due on the one hand to an increase in male life expectancy and, on the other, the demands of a society that requires a greater quality of life, now that elevated levels of health and longevity have been achieved.

What is the Andropause?

The Andropause is defined as the gradual decline of all the physiological functions of the male, from the cognitive to the physical, including the loss of concentration and memory; muscular weakness, increase and redistribution of fat; reduction in bone mass and osteoporosis; reduction in appetite and sexual potency, etc.

Currently, in relation to the deficit of androgens (male hormone) this ageing process is defined as the ADAM syndrome (Androgen Deficiency Ageing Male).

How is it diagnosed?

Clinical diagnosis of the andropause is not easy.  It is not found in all males, or at the same age, or in such an obvious manner as women with their loss of menstruation during the menopause.

The clinical symptoms of ADAM syndrome are varied.  There may be a lessening in sexual desire and in the quality of erections, with a reduction in nocturnal erections.  Character changes may occur, with a reduction in intellectual activity, memory, spatial awareness, with fatigue, tendency to suffer from depression, mood swings and irritability.  It is associated with reduction in muscular mass together with a lessening in strength and physical resistance.  Loss of body hair is produced, together with skin alterations, reduction in bone density with a tendency to osteoporosis and an increase and redistribution of visceral fat (Table 1).

To investigate its appearance and facilitate its clinical diagnosis, various questionnaires have been formulated with the most commonly used one that of the San Luis University  (Table II).

With regard to analytical diagnosis, the most relevant data is the reduction in the active fraction of testosterone in the blood (male hormone par excellence).

When and how can it be treated?

Treatment would be indicated in those cases in which the androgenic deficiency was notable from an analytical point of view and associated with evident clinical changes, always providing there was not a formal contraindication for replacement treatment with androgens such as the existence of prostate cancer.

The fundamental objective of the treatment is to replace the levels of testosterone in order to restore sexual function, the libido and the will to live, simultaneously achieving other objectives such as the prevention of osteoporosis, maintaining physical strength and vigour and intellectual capacity.

There are various forms of testosterone replacement therapy such as intramuscular or oral administration, and more recently transdermally with patches and gels, and currently in research phase, subcutaneous implants.

The treatment must always be carried out under medical supervision due to the effects that this therapy may have upon the lipids, retention of liquids and the prostate, amongst others, with the patient requiring regular re-evaluations for monitoring purposes to ensure there are no undesirable effects and to control the effectiveness of same.

TABLE I. CLINICAL SYMPTOMS

Reduction in sexual desire and quality of erection. Reduction in nocturnal erections. Changes in character, reduction in intellectual activity, memory, spatial awareness, with fatigue, depression, mood swings and irritability. Reduction in muscular mass with reduction of strength and physical vigour. Reduction of body hair and skin alterations. Reduction in bone density and osteoporosis. • Increase and redistribution of visceral fat.

TABLE II. SAN LUIS UNIVERSITY QUESTIONNAIRE

Has your sexual appetite reduced? Do you feel a lack of energy? Has your strength and physical resistance diminished? Have you lost height? Have you noticed a reduction in your will  to live? Do you feel sad and irritable? Are your erections less powerful? Have you noticed your ability to do sports diminish? Do you fall asleep after dinner? Have you noticed a reduction in your capacity to work?