A 56-year-old male is concerned about some symptoms he has progressively noted over the past six months. He has lost almost all interest in sex with his wife. He no longer gets early morning erections and he cannot recall the last time he had sex. He is chronically fatigued and snaps at his wife for the simplest things. His manager at work has made complaints due to his poor work performance and noted lethargy on the job. He is now concerned because his wife is threatening to move out of the matrimonial home.

In the last issue, we discussed andropause (reduced testosterone levels with advanced age) and its symptoms. The reduced libido, erectile dysfunction, irritability and lethargy noted in this man are typical of symptoms of andropause. With the rapid growth of the world population and increase in life expectancy, more cases of andropause will be seen.

Why isn't andropause discussed and treated more often?

A lot of men with these symptoms are embarrassed and afraid to seek medical attention. Unfortunately, some men feel that these symptoms are normal and acceptable with increasing age. The phenomenon of andropause is not well known and discussed and hence most patients with the condition do not seek treatment.

Can other medical conditions mimic andropause?

It is always important for the physician who treats men with andropause to exclude other conditions whose symptoms are similar to those of andropause. These include depression, thyroid disorders, alcoholism, stress and use of certain medications.

How is andropause diagnosed?

All men with symptoms of andropause should have an early morning blood test that measures total testosterone levels. A combination of symptoms and low testosterone level establishes the diagnosis.

Can men younger than 40 get andropause?

Young men can get similar symptoms seen in andropause. Technically, the condition is called hypogonadism, and may be due to a variety of causes. It is treated in a similar way as andropause.

How do we treat andropause?

Treatment of andropause involves replacing the testosterone hormone. Testosterone comes in various forms: skin patches, gels, injections. In Jamaica, a testosterone substitute exists which is given as an injection every three months.

Is testosterone treatment effective in treating andropause?

Men note improvement in sex drive and erections after treatment with testosterone. Other improvements noted are improvement in bone density and muscle mass. The treatment is effective and safe. Emerging results of studies have shown that this treatment does not increase the risk for prostate cancer.

All men treated for andropause must be monitored carefully by their physician. Testosterone blood levels should be checked frequently and symptoms evaluated. I encourage all men who have symptoms of andropause to visit their doctor and seek treatment. Do not suffer in silence.

Dr Belinda F Morrison is a urologist and lecturer at the University of the West Indies. Contact her at belinda.morrison02@uwimona.edu.jm.