Is hypogonadism, aka "andropause", the male version of menopause?

Many men who reach middle-age start to experience symptoms that resemble those of menopause; reduced libido, lack of energy, weight gain, fatigue, depression and osteoporosis, to name a few.[1-5]

 

Therefore these conditions are frequently seen as being equivalent, and hypogonadism (which sometimes get the prefix "late onset") has therefore been called "andropause", "male climacteric", "male menopause" or "MANopause.[6, 7] 

 

However, this is very misleading. In this article I will contrast and comment on the differences between hypogonadism, also known as testosterone deficiency, and menopause.[8]

 

 

For several reasons, hypogonadism in men and menopause cannot be equated: 

 

Testosterone deficiency often manifests with symptoms in men that resemble those of menopausal women.[1, 5, 9, 10] This has given rise to the idea of "andropause", "male climacteric" and "male menopause". However, for several reasons, this parallel is fraught with misinformation and irrational logic that lacks a scientific base.

 

 

Hypogonadism, also known as testosterone deficiency, while common [11], does not universally affect every man. It has been shown that testosterone levels display no decrease associated with age among men over 40 years of age who self-report very good or excellent health.[12] This may indicate that a large part of the age-related decline in testosterone levels is due to accumulating age-related co-morbidities, rather than an age-specific phenomenon. This view is supported by data showing that besides age per se, obesity, metabolic syndrome, diabetes and dyslipidemia are risk factors of incident hypogonadism.[13] Thus, while menopause happens consistently in women between the ages of 45-55, the median age for natural final menstrual period is 52 years [14], hypogonadism in men can occur at any age because testosterone deficiency can be caused by several different factors.[10, 15] Therefore, the term "late onset hypogonadism" is inappropriate. The terms testosterone deficiency and hypogonadism are more accurate.

 

Male testosterone deficiency develops slower and more progressively over time, while menopause signifies a relatively abrupt cessation of estradiol production. In both cross-sectional [16-21] and longitudinal studies [22-25], beginning in the third decade in men, testosterone levels start to decline gradually and progressive at a rate of approximately 1% per year.

 

Equating late onset hypogonadism and menopause also disguises the facts that these phenomena are caused by different hormones, and that their respective deficiencies result in vastly difference consequences. While it is hypothesized that estrogen deficiency in women may be protective against cancer [26, 27] and may increase longevity [28], testosterone deficiency in men is associated with a myriad of detrimental health outcomes, including obesity, increased waist circumference, insulin resistance, type 2 diabetes, hypertension, inflammation, atherosclerosis and cardiovascular disease, erectile dysfunction (ED) and increased mortality.[29] Testosterone deficiency in men may even be a risk factor for cardiovascular disease.[30, 31] In addition, there are also indications that testosterone deficiency in men contributes to the gender gap in cardiovascular morbidity and mortality.[32] When it comes to the prostate, testosterone deficiency may actually, to the contrary of old dogma, have a negative impact on prostate health, as we have reported in a previous editorial insert link here.

 

When it comes to the issue of treatment vs. non-treatment, a rapidly expanding body of evidence justifies treatment of hypogonadism with testosterone therapy.[33-52] This is in stark contrast to menopause, whose treatment with estrogen HRT (hormone replacement therapy) with is controversial; studies show it doesn't always improve symptoms and in may pose an excessive risk for women with a family history of breast cancer.[53-57] The most serious concern about traditional HRT with synthetic estrogen and progesterone is its potential to increase risk for breast and endometrial cancer, blood clots, stroke and heart disease (I will cover the benefits of bioidentical estrogen and progesterone compared to synthetic in an upcoming article).[58] In contrast, treatment of hypogonadism in men with testosterone therapy that achieves adequate testosterone levels and is of long enough duration to allow benefits to manifest [59] improves symptoms and reduces risk of multiple chronic diseases, including cardiovascular disease, in the vast majority of men.[34, 36, 39-42, 45, 46, 48-51, 60-66] 

 

An important reason to distinguish hypogonadism from menopause is because of concerns about HRT in postmenopausal women have been inappropriately extrapolated to men; "such extrapolation is not only inappropriate but it lacks any scientific evidence or validity - predicting the effects of testosterone replacement in hypogonadal men by relying on studies of estrogen (with or without progesterone) in postmenopausal women is baseless and should be condemned."[67]

 

The conclusion by Saad and Gooren that testosterone treatment in hypogonadal men is far more compelling than estrogen treatment of postmenopausal women is well backed up by solid scientific research and provides a timely message to practicing clinicians who still think that "andropause" or "male climacteric" should be approached like menopause.

 

 

References:

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