PADAM: “Menopause” in Men?

Until now, the programmed hormonal decline from an age of about 50 years was exclusively a matter for women, but the ravages of time also gnaws at the body, psyche and sexual experience in men. PADAM is one of the buzzwords used to describe a complex of symptoms for which a decline in the production of sex hormones in men after a certain age is held responsible.

Andropause, PADAM or climacteric virile?

There is disagreement about the correct term for the hormone decline in aging men: some refer to the symptoms as climacterium virile or andropause, others as midlife crisis, and still others as PADAM – the partial androgen deficit of aging men. But which term is the most appropriate? The terms climacteric virile and andropause (in reference to menopause in women) describe the phase of a man’s life when his testosterone levels drop. However, this is not comparable to menopause in women. Although there is a hormonal change in both cases, the female sex hormones no longer predominate in women after menopause. In men, on the other hand, testosterone predominates throughout their lives. Therefore, the terms climacterium virile and andropause do not accurately describe the decline of male sex hormones in older men from a biological-scientific point of view. The term midlife crisis, on the other hand, only takes psychosocial aspects into account. Endocrinologists in particular have taken a liking to the term PADAM – the partial adrogen deficit of the aging male, which best describes the actual biological conditions.

What are androgens?

Androgens are sex hormones that control the development of male sexual characteristics. These include, for example, beard growth or voice and muscle development. The production of androgens – of which testosterone is one of the main representatives – takes place in the testes and adrenal cortices, and in smaller amounts in the ovaries.

After the age of 40, testosterone levels begin to decline

Unlike women, in whom sex hormone levels drop off relatively abruptly with the last menstrual period, testosterone production in many men – but not all – begins a slow but steady decline. This process usually takes place between the ages of 40 and 70. The blood of a healthy man contains between 12 and 30 nanomoles of testosterone per liter of blood serum, depending on the time of day and lifestyle. Evidence shows that testosterone levels naturally decrease by about one to two percent each year after the age of 40.

PADAM – Partial adrogen deficit in the aging male.

A testosterone deficiency in aging men is commonly referred to as testosterone deficiency syndrome or the technical term partial adrogen deficit of the aging male. The phenomenon of declining testosterone levels can basically be observed in every man, but it starts from different initial values. This is because, in addition to genetic predisposition, external factors also influence hormone production. These include:

  • Diet and obesity
  • Drugs and alcohol
  • Stress
  • Exercise
  • Acute diseases such as infections
  • Chronic diseases such as arteriosclerosis, diabetes, liver or kidney disease
  • Certain medications such as psychotropic drugs or antihypertensive drugs.

This explains the wide differences in the occurrence of PADAM symptoms. Thus, some men with over 70 years still have testosterone levels in the normal range, while others have to deal with symptoms of testosterone deficiency already from 50 years.

PADAM: Symptoms vary

What is clear is that declining testosterone output is a natural side effect of aging. There is also a proven link between patients with general diseases such as diabetes and low testosterone levels. The general state of health is therefore sometimes responsible for the testosterone levels in the blood. As varied as the tasks of male sex hormones are, as varied can be the complaints caused by a deficiency of androgens – and testosterone in particular. Possible symptoms include:

  • In some, the mood is in a permanent low, the drive is missing, and performance and concentration decline.
  • Others struggle with sleep disturbances, hot flashes, increased night sweats or palpitations.
  • As for sexuality, libido, sexual activity, erection strength and duration decrease.
  • In addition, muscle strength dwindles and the risk of osteoporosis increases.
  • The older man gains body weight and fat mass, especially in the abdomen. In the course of androgen deficiency may manifest anemia, with all the possible consequences of a reduced number of oxygen carriers.

One thing is certain: testosterone deficiency is not manifested by a clear clinical sign, but varies in appearance. It is also possible that PADAM is not only the result of a testosterone deficiency, but rather that of a disturbed balance between different hormones such as testosterone, growth hormones, estrogens and DHEA (dehydroepiandrosterone).

Hypogonadism – hormonal dysfunction.

If testosterone levels are below 12 nanomoles per liter of blood serum (or 3.5 nanograms per milligram), the condition is called hypogonadism. In men, this is understood to mean impaired function of the sex glands. The result is falling testosterone levels. The symptoms depend on the age of the person affected, which is why a common form is also called senile hypogonadism. Characteristic here is the decreasing function of the testicles. Other consequences may include:

  • Reduced libido (up to their loss).
  • Reduced vitality
  • Erectile dysfunction
  • Reduced muscle mass
  • Reduced bone density
  • Anemia (anemia)
  • Anosmia (loss of the sense of smell)
  • Depression

Hormone therapy with testosterone

Targeted hormone replacement should be considered when, in addition to PADAM symptoms, a man has a clear testosterone deficit of less than 3.5 nanograms per milliliter of blood. Thus, the indication is given when the symptoms are combined with laboratory-confirmed hypogonadism.

Testosterone via injections, capsules, or patches

In terms of treating their symptoms, menopausal women have the better cards. Gynecologists can choose from more than fifty preparations plus various dosage gradations in the different forms of application – transdermal (via patches), peroral (by mouth), vaginal, and intramuscular. For men with clinically proven testosterone deficiency, on the other hand, pharmaceutical chemistry has only one substance available, namely testosterone. Testosterone can be administered as an injection, capsule, patch or gel. The physician must decide which of these forms of administration is most suitable for the patient. In general, however, only mild testosterone deficiencies are usually treated through the skin – i.e. via patch or gel. In contrast, testosterone is often injected. In the meantime, depot injections are available for this purpose. This means that the injections only need to be administered at intervals of a few weeks.

Effects of testosterone substitution: increase in lean body mass.

Beginning around the sixth decade of life, muscle mass and strength begin to decline in many men. A 70-year-old carries about 12 kilograms less lean body mass, of which muscle makes up most, than a 25-year-old. At the same time, fat tissue increases. Testosterone substitution can take corrective action here. Studies suggest that testosterone replacement therapy can increase the proportion of lean body mass, regardless of whether the subjects are healthy, men with a pronounced testosterone deficiency or older men with a slight deficit. Similar positive effects are seen with muscle mass and strength, because the increase in lean body mass goes hand in hand with the buildup of muscle.

Osteoporosis due to testosterone deficiency.

Although osteoporosis still affects women in most cases, it also affects men. Not always the classic risk factors such as alcohol consumption, systemic diseases or immobilization can be identified. This is because a testosterone deficiency in old age also leads to reduced bone mineralization and thus promotes the development of osteoporosis. Hormone therapy with testosterone may therefore conversely improve bone density.

Other effects of testosterone replacement therapy: promotion of blood formation.

Furthermore, it is scientifically proven that testosterone substitution stimulates erythropoiesis, or blood formation.Proponents of testosterone substitution attribute an improvement in general physical performance to the increased oxygen transport capacity. However, this has not been clearly proven.

Testosterone substitution and psychological well-being.

It is difficult to find out how testosterone administration affects mood and psychological well-being. Sound data are scarce and come only from small groups of patients. However, the results are satisfactory. For example, studies suggest an improvement in depressive moods and a decrease in anxiety, fatigue, and listlessness.

Loss of libido and impotence disorders.

A not insignificant aspect of quality of life is sexual function, which is also increasingly aging in older people. Estimates suggest that about half of men over age 60 experience potency problems, and about 15 percent are impotent. While the loss of libido is probably due to a testosterone deficit, the frequently complained of potency disorders almost always have several causes and can rarely be remedied by testosterone substitution. Therefore, potency disorders as an isolated symptom are not a reason for testosterone therapy.

Contraindications to testosterone replacement therapy.

It is essential to refrain from hormone therapy with testosterone in the case of prostate carcinoma. This is because additional administration of testosterone would cause the tumor to grow faster. Difficulty in urine flow due to an enlarged prostate is also one of the contraindications. To avert possible complications, men who are treated with hormone replacement therapy should have their blood and liver values as well as their prostate regularly checked by their doctor.

Testosterone replacement in PADAM?

Whether testosterone therapy might have value in age-associated complaints independent of laboratory-proven hypogonadism has not yet been clearly established. However, most arguments are against it. This is because a mild androgen deficiency can also be caused by an unhealthy lifestyle or psychological stress. In addition, the administration of testosterone promotes the growth of prostate cancer, for which the risk is already increased in older men. Ultimately, there is no firm scientific evidence that therapy with testosterone is appropriate for age-related low testosterone levels. For this reason, most physicians advise against artificial testosterone administration for age-related slightly lower testosterone levels.

PADAM symptoms are part of aging

PADAM complaints such as hot flashes or night sweats are therefore completely normal in aging men and no reason for major concern, because the testosterone level decreases gradually in a natural way. Only when medically verifiable hypogonadism is present is hormone replacement therapy appropriate.