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Does the male menopause exist?
From: netdoctor          Published On: August 20, 2013, 9:36 GMT
 
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Does the male menopause exist?

Both men and women undoubtedly experience symptoms related to reduced production of sex hormones (sex steroids) as they get older. These changes are inevitable, but affect individuals differently.

In men, the fall in sex hormone production is much more gradual, developing over decades rather than months or years. As such, the term 'male menopause', or andropause, is probably not accurate. Instead, experts prefer to talk about 'Partial Androgen Deficiency of the Ageing Male' (PADAM).

What are androgens?
Androgens are steroid hormones with specific effects on tissue growth (muscle, fat, skin, hair and others) and brain function. They play important roles in both men and women, but are produced in much larger quantities in men.

In men after puberty, the majority of androgens are produced by the testicles, mainly as testosterone.
Other androgens dehydroepiandrostenedione (DHEA), its sulphate (DHEAS), and dihydrotestosterone (DHT) are produced in the adrenal cortex, skin and liver. Several man-made androgens are also available.

Androgen deficiency can occur in younger men, and even in children and adolescents, as a result of testicular damage, genetic disorders or metabolic disorders.

It's very important that they receive expert assessment by an endocrinologist at an early stage and receive androgen replacement therapy.

What are the symptoms of androgen deficiency?
The symptoms of PADAM are numerous and non-specific, so it is not an easy condition to diagnose. They include problems with the following.

Circulation and the nervous system
hot flushes
sweating
insomnia
nervousness.

Mood and cognitive (higher mental) function
irritability and tiredness
decreased sense of well-being
lack of motivation
low mental energy
difficulty with short-term memory
depression
low self-esteem
being easily frightened.

Masculinity and virility
decreased vigor and physical energy
diminished muscle strength.

Sexuality
decreased interest in or desire for sex
less sexual activity
poor erections
reduced quality of orgasm
weakness of ejaculation
reduced volume of ejaculated fluid.

Physical features include
diminished muscle mass
loss of body hair
abdominal obesity.

What are the consequences of androgen deficiency (PADAM)?
Changes caused by PADAM could potentially affect health in several ways:
increased risk of osteoporotic fracture and cardiovascular disease
reduced general wellbeing
depression
cognitive impairment (problems with thought, concentration and memory)
reduced physical strength
sexual problems.

The symptoms, signs and metabolic consequences of androgen deficiency are largely reversible, and can be corrected by replacement therapy.

How is androgen deficiency (PADAM) diagnosed?
No definitive test for PADAM exists. Low blood levels of testosterone alone are insufficient to make the diagnosis.

The combination of several different suggestive symptoms and physical signs, together with low blood levels of testosterone, should raise suspicion that PADAM is present.

Treatment
Many doctors do not believe that PADAM exists and will not offer treatment. Others are 'believers' and see it everywhere. Some men take in testosterone supplements.

Men receiving testosterone supplements should have regular medical checks every three months for the first year of treatment, which must include a rectal examination of the prostate gland (which sits beneath the bladder producing fluids that nourish and protect sperm) and blood tests.



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