Many men in the middle stage of life show symptoms similar to those experienced by women in menopause (menopause). As diverse as the tasks of androgens – the male sex hormones – are, as diverse can be the symptoms and complaints that arise or are caused by a lack of androgens – essentially by testosterone. The following is an overview of typical complaints during andropause (menopause in men)/signs of a testosterone deficiency/androgen deficiency symptoms (male hypogonadism):
Mental disorders
- Decreased self-esteem
- Increased irritability
- Chronic fatigue
- Insomnia (sleep disorders)
- Drive disorders
- Depressive mood disorder*
- Lack of concentration, memory impairment
- Mood swings, fatigue (exhaustion) and aggression.
Vasomotor vegetative disorders
- Hot flashes and sweating (possibly also night sweats/nocturnal sweating).
- Circulatory problems
Organic disorders
- Decreasing efficiency
- Decrease in testicular volume
- Decrease in nocturnal erections
- Decrease in libido / loss of libido
- Erectile dysfunction* (erectile dysfunction, ED).
- Dry and brittle skin
- Joint, skeletal and muscular pain
- Anemia (anemia)
- Decrease in the efficiency of the immune system
- Decreased cognitive function
- Loss of body hair; decrease in hair density.
- Decreased beard growth
- Male infertility
- Gynecomastia – enlargement of the mammary gland of the male
- Insulin resistance – decreased effectiveness of the body’s own insulin at the target organs skeletal muscle, adipose tissue and liver – and diabetes mellitus type II.
- Metabolic syndrome
- Osteoporosis (bone loss)
- Change in body composition
- Increase in body weight with increase in body fat percentage.
- Increase in visceral adipose tissue* .
- Decrease in lean body mass and muscle strength/sarcopenia (loss of muscle mass and muscle strength and functional decline).
* Increase in visceral adipose tissue (abdominal fat), erectile dysfunction, depressed mood, and drop in testosterone with age makes the diagnosis of late-onset hypogonadism (LOH) or symptomatic late-onset hypogonadism (SLOH) highly likely. Clinical signs of androgen deficiency (mod. by).
| Specific signs | Non-specific characters |
| Gynecomastia, chest pain | Listlessness, loss of motivation |
| Flushing symptoms, sweating | Impaired concentration, possibly memory loss |
| Erectile dysfunction (ED) loss of libido | Depression |
| Infertility | Insomnia (sleep disorder) |
| Incomplete sexual development | Mild anemia (anemia) |
| Loss (absence) of secondary hair growth | Increased BMI, increased body fat mass |
| Small testicular volume (< 5 ml) | Decreased performance |
| Osteopenia (reduction in bone density), fractures (broken bones) due to inadequate trauma | reduced muscle strength |
Adult male serum testosterone levels range from 12 to 40 nmol/l (3.6 to 12 ng/ml). At the same time, serum levels are subject to diurnal fluctuations. Levels are lowest in the evening between 6 and 10 p.m., and are 35% higher than average levels in the early morning. Signs of the morning “peak values” are, for example, the frequent morning spontaneous erection. In aging men, morning levels initially become lower. Eventually, serum testosterone levels slowly decline. A 70-year-old man reaches only two-thirds of the testosterone levels of a young man. If the level falls below 12 nmol/l (3.6 ng/ml), there is a partial androgen deficit, which can draw attention to itself through the complaints/symptoms described above.The EAU guideline gives the following guide values:
| Total testosterone | ||
| Normal range | ≥ 12.1 nmol/l | 3.5 ng/ml (μg/l) |
| Limit range | 8-12 nmol/l | 2.3-3.46 ng/ml (μg/l) |
| Testosterone deficiency | < 8 nmol/l | < 2.3 ng/ml (μg/l) |
| Free testosterone | ||
| Testosterone Deficiency | <243 pmol/l | |
Note
- Blood collection is done in the morning (8:00-10:00 am).
- If necessary, perform three blood collections to make a determination from “pooled” serum.
- Perform the measurements at a time interval of at least 2 weeks to exclude other factors that may temporarily lower testosterone levels, such as a cold or lack of sleep.
- If the testosterone level is close to the lower normal range, secure the diagnosis by laboratory determination or calculation of free testosterone.
- Laboratory calculator: determination of free testosterone from total testosterone, albumin and SHGB.