Testosterone deficiency in men in old age is also known as andropause in medicine. Testosterone is the most important male sex hormone. It is instrumental in male development and growth. With age, the production of testosterone decreases, which can lead to erectile dysfunction and osteoporosis, among other things.
What is testosterone deficiency?
The term testosterone is composed of “testis” (testicles) and “steroid”. The sex hormone is produced in the so-called Leydig’s intermediate cells, which are located in the testicles. Testosterone causes the formation of sexual characteristics even before birth and ensures their further development and sperm production during puberty. It also contributes to the growth and maintenance of the entire body. On the one hand, testosterone ensures a deeper voice, muscle development, thicker skin, increased metabolism, body hair formation (not head hair) and the sex drive of men, and on the other hand, it causes hair loss and the male “imponiergehabe”. (However, women also produce testosterone in the ovaries and adrenal cortex, but far less than men do). Testosterone levels in men peak between the ages of twenty and thirty, after which production of testosterone declines by about one to two percent annually.
Causes
The causes of testosterone deficiency in men as they age lie in the natural aging process and the physical changes that accompany it, although an unhealthy lifestyle and lack of exercise can also limit testosterone production. The decreasing concentration in old age of other hormones that help regulate testosterone also contributes to testosterone deficiency. During this stage of life, known as “andropause” or “climacteric vinile” among other things, a man’s testosterone levels drop to such an extent that there are noticeable changes, both psychological and physical, which the man may be able to ignore but cannot deny. This process can therefore certainly be understood as a counterpart to menopause in women, even though in men the male sex hormones continue to predominate in principle. “Late-onset hypogonadism” is the name given to the most common form of reduced testosterone production. About 30 percent of all men over 40 are affected by this testosterone deficiency.
Symptoms, complaints and signs
The age-related decline of the sex hormone testosterone in men shows a variety of signals. In the life phase from 60 to 75 years, about one fifth suffers from it. Unlike in women, the hormonal remodeling is gradual and less pronounced. A general sign of the deficiency is physical stamina, which noticeably decreases. Psychologically, the declining motivation is noticeable, which becomes apparent in a wide variety of topics. Overall, life satisfaction declines significantly. Three symptoms in particular are typical of andropause. They directly affect sexual life and do not remain hidden from the partner. The previously rapid erection and its strength are reduced. In addition, the physical desire weakens. As a third sign of dwindling male strength, the previously regular morning swelling of the penis occurs less frequently. In sum, the psyche suffers enormously. In a number of those affected, other complaints develop, which manifest themselves differently in each man. The physique changes due to the decrease of muscle mass and the increase of fatty tissue. The main hair slowly becomes thinner and the beard growth weaker. Some patients suffer from persistent nervousness, inner restlessness and sleep disturbances. Rarely, previously unknown attacks of sweating and heat occur. Some find it difficult to concentrate for longer periods. In addition, there are signs of memory weakness. In individual cases, depression is not absent.
Diagnosis and course
To determine testosterone deficiency in men as they age, blood serum is usually examined. To achieve a reliable diagnosis, the blood sample must be taken in the morning, as the testosterone level is subject to strong fluctuations during the day. For example, it reaches its highest value early in the morning, while this drops to a minimum in the afternoon. Signs of reduced production of testosterone can include erectile dysfunction and a general decrease in potency and libido.Likewise, osteoporosis, the reduction of physical and mental performance, palpitations and sleep disorders are among the consequences of testosterone deficiency.
Complications
Testosterone deficiency in men as they age can lead to various complications. In the first place, those affected suffer from very pronounced muscle weakness. This also results in weight gain, so that those affected are dissatisfied with their weight and often also with their appearance and are ashamed of it. Permanent fatigue and exhaustion also occur and cannot be compensated by sleep. Most of those affected also suffer from depression or inner restlessness as a result of the testosterone deficiency in men as they get older. In children, testosterone deficiency in men can lead to severe restrictions in growth and development. Children are often tired and unable to concentrate. Likewise, the complaint can have a very negative effect on sexual desire, possibly leading to discomfort with one’s partner. In most cases, the disease is treated with the help of hormones. Complications do not occur. However, those affected are usually dependent on taking them for the rest of their lives. If the testosterone deficiency in men is triggered in old age due to an underlying disease, this must also be treated.
When should you go to the doctor?
Changes in hormone balance are normal over the lifespan and are part of the natural process. A doctor is not always needed when they occur. The decline of testosterone occurs in men over the age of 60 or later. It occurs slowly and insidiously. Normally, this development does not require a visit to the doctor. If the affected person suffers from the physical changes, he should consult a doctor. The decrease in libido or sexual activity is considered a natural process. If the affected person notices that he is not in harmony with this, the changes should be discussed with a doctor. If there are disturbances in sleep, night sweats or heat attacks, consultation with a physician should be sought. Changes in hair growth, disturbances in personality as well as emotional feelings should also be examined more closely by a doctor. Although the complaints are considered natural in men at an advanced age, it must be clarified whether other diseases are present. An inner restlessness, nervousness and a feeling of imbalance are also among the complaints of a testosterone deficiency. If the affected person is under 60 years of age, he should basically initiate a visit to the doctor in case of the complaints. Here, the testosterone deficiency indicates other discrepancies that should be investigated.
Treatment and therapy
Various therapies are used to treat testosterone deficiency in men as they age. In all of them, the testosterone that the body lacks is supplied from outside. The oldest form of hormone treatment is called monthly injection. This is given at intervals of three to four weeks, although the testosterone level can still be subject to strong fluctuations. Better results are achieved with a special gel that is applied daily to the skin. The scrotal patch, which is applied daily to the scrotum, also keeps testosterone levels relatively constant, but some men find it annoying. The 3-month injection is still a new form of treatment with good results. It has the advantage that the testosterone deficiency in men can be reversed over a longer period of time without having to worry about it. In some countries it is possible to insert testosterone implants under the skin. Through a short, outpatient procedure, testosterone levels can thus be maintained over a period of six months. However, little is known about long-term damage and other risks triggered by the external administration of testosterone. Similarly, there are numerous potential side effects (such as thrombosis, depression, stroke, damage to the heart muscle, or formation of liver and kidney tumors) that can occur specifically with synthetic testosterone delivery.
Prevention
To best prevent testosterone deficiency in men as they age, emphasis should be placed on a healthy lifestyle and balanced diet, as well as exercise.Since stress, obesity, alcohol, drugs and certain medications such as psychotropic drugs or corticosteroids also negatively affect testosterone levels, it can be summarized that testosterone deficiency in men as they age can at least be alleviated by changing their habits.
Aftercare
During testosterone replacement therapy, it is of great importance to monitor the prostate through regular checkups to detect the development of prostate carcinoma early. The treatment interval should initially be three to six months and then again after one year. The examinations should then be continued annually. The parameters to be monitored are the tumor marker PSA and rectal examination of the prostate. Since testosterone leads to increased erythrocyte formation, the hematocrit and hemoglobin value should be determined regularly. The fluidity of the blood should be monitored to counteract thromboembolic events. Studies showed that the start of substitution therapy with testosterone is associated with an increased risk of thromboembolism. The risk of such a serious adverse event is highest in the first three months after initiation of therapy. In the case of pre-existing cardiological conditions, regular check-ups should also be performed. Therapy successes are seen over a period of months and sometimes even years. The fact that the lack of male hormones can also lead to psychological impairments should not be ignored. For this reason, psychotherapeutic support therapy should also be offered during aftercare. The offer of self-help groups is also an important component of holistic aftercare.
What you can do yourself
Andropause is a natural phenomenon that subsides on its own after a few months. Treatment is only necessary if symptoms occur. Hormone replacement therapy may be useful for symptoms such as hair loss or mood swings. The man should seek treatment at an early stage and ideally talk to his family doctor about the symptoms. The therapy can be supported at home by a change in diet and various general measures. The diet should be balanced and healthy during this break. It is also recommended to spend a lot of time outdoors to stimulate the body’s testosterone production. In addition, exercise should be done. Physical exercise contributes to a healthy hormone balance and can counteract the typical symptoms of a testosterone deficiency. In consultation with the doctor, various potency-increasing agents are also available. Which measures are useful in detail must be discussed with the doctor. Middle-aged men who notice symptoms of andropause are best advised to talk to their family doctor. The physician can perform a physical examination and suggest a suitable therapy based on the results. If necessary, other specialists can be consulted, as well as nutritionists and sports physicians.
