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Andropause: hormone replacement therapy?

Age is associated with physiological changes in all spheres of the individual, both in men and in women. The menopause is caused by the loss of activity of ovarian follicles and leads to the absence of menstruation and important biological changes in women.

In men, the equivalent would be ” andropause “, a process less defined in time, with secondary clinical, psychic and biological changes due to the progressive decrease in the production of testosterone in the testicle. There are multiple studies that show that with age there is a reduction in the size and weight of the testes, and a reduction in the number of Leyding cells that make testosterone.

In addition, there is an alteration in the hormones of the hypothalamus that control the activity of the testicle, with a decrease in secretory pulses of gonadotropin-releasing hormone (GnRH). Other steroid hormones of adrenal origin (dehydroepiandrostenedione, pregnenolone) also decline with age, contributing to clinical changes in “andropause.”

The most pronounced biological changes occur in sexual activity. It is proven that in men there is a decrease in libido, the frequency of sexual intercourse and the hardness of penile erections. There is a decrease in muscle strength and capacity for physical exercise, possibly related to the role of testosterone in muscle protein synthesis. Decreased testosterone increases ‘leptin’ levels in older men.

This hormone is produced in fat tissue, and its increase is related to changes in body composition, with an increase in fat mass and body weight. There are studies that show an increase in bone fractures in elderly men, in relation to the loss of bone mass ( osteoporosis ). The existence of androgen receptors in bone has been demonstrated, although the role of androgens in maintaining bone mass is not as well defined as that of estrogens in women. Studies using testosterone in adult males with low testosterone levels show increased bone density.

In animals, testosterone replacement has been shown to increase memory and cognitive ability. Human studies show results that are more difficult to evaluate, although it seems clear that “quality of life tests” improve in patients treated with this hormone.
Testosterone use was initially thought to increase the risk of cardiovascular disease.

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It has been proven that in older adults, not only does it not modify the lipid profile (LDL-cholesterol, HDl-cholesterol), but it can also improve the flow of the coronary arteries.
Testosterone replacement therapy has been used since 1889 (Brown-Sequard), and throughout the 20th century it has been used with very different results.

Currently, we can say that testosterone treatment in “andropause” would improve libido and the power of erections, muscle strength, exercise capacity and the distribution of body fat; it would prevent bone fractures, improving bone density; and it would probably improve some aspects of the male’s cognitive activity. The influence on mortality and morbidity of cardiovascular origin remains to be defined.

The problems that arise today to start treatment with testosterone are several:

  • The first would be to define the onset of “andropause,” which, unlike menopause , produces clinical and biochemical changes that are more difficult to detect.
  • The second, and most important, would be the side effects of the treatment. The use of testosterone produces an increase in the production of red blood cells, thus increasing the viscosity of the blood. Breast tissue (gynecomastia) and hydrosaline retention may appear. It is not clear that it causes hypertrophy of the prostate or elevation of the prostate specific antigen (PSA), but its use is completely contraindicated in patients with prostate cancer, since it is a tumor whose growth depends on this hormone.
  • Lastly, neither the type of preparation (intramuscular, patches….), Nor the dose, nor the duration of treatment with testosterone in adults with “andropause” have yet been defined.

In conclusion, the changes in men with age must be defined more precisely, and although the possible benefits of testosterone replacement therapy seem to outweigh the risks, more studies are needed to support hormonal treatment in men with Andropause.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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